Multidisciplinary approach to anaplastic and metastatic meningioma: A case report and review of the literature

Background: Meningiomas are slow-growing neoplasms, accounting for 20% of all primary intracranial neoplasms and 25% intraspinal tumors. Atypical anaplastic meningiomas infrequent, representing fewer than 5% meningiomas. Unusually, they can show aggressive behavior, extracranial metastases extremely rare, approximately 0.1% reported cases. Case Description: Fifty-six-year-old male patient diagnosed with atypical basal frontal meningioma multiple resections, both endoscopic endonasal transcranial. After hypofractionated radiosurgery, the showed new tumor recurrence associated to right cervical level II ganglionic metastasis. We opted complete resection reconstruction anterior rectus abdominis muscle flap, as well selective ganglionectomy. Anatomical pathology neoplastic proliferation meningothelial cells in syncytial cytoplasm, oval or spherical nuclei slight anisocariosis hyperchromasia, intranuclear vacuoles, compatible meningioma. Conclusion: Due a lack consensus on how treat metastatic malignant meningioma, this requires multidisciplinary approach, treatment needs be adapted each particular case. Complete lesion is goal, complex procedures involving endocranial surgeries, which result composite defects difficult resolve. Microvascular free flaps considered gold standard reconstructions large skull base defects, high success rates few complications.