Angiomatous Meningioma With Postictal Hemiparesis: Clinical Presentation and Surgical Challenges in a Rare Case

Angiomatous meningioma (AM) is a rare histological variant of meningioma characterized by prominent vascular proliferation, often posing intraoperative hemostatic challenges. We report the case of a 42-year-old man presenting with recurrent generalized tonic-clonic seizures and postictal right hemiparesis. CT imaging revealed a large, enhancing left parietal mass with marked perilesional edema and mass effect. In this rural setting, MRI and cerebral angiography were unavailable, requiring surgical planning to rely solely on CT findings. The patient underwent a wide left parietal craniotomy, where a highly vascular lesion was encountered. Early devascularization of dural feeders, stepwise debulking, and meticulous microsurgical dissection achieved gross total resection (Simpson grade II) with effective hemostasis. Histopathology confirmed AM. Postoperatively, the patient showed progressive neurological improvement, remained seizure-free, and was discharged on oral levetiracetam; follow-up imaging confirmed complete resection. This case underscores the need to consider AM in patients with seizure-related hemiparesis and demonstrates that, even without advanced vascular imaging, careful CT-based planning and precise microsurgical technique can yield excellent outcomes in resource-limited environments.