Clinical image: rare localization of a giant recurrent malignant meningioma

Meningiomas are the most common benign brain tumors. Malignant meningioma is a rare subtype with a high recurrence rate and poor prognosis. Most meningiomas grow intracranially, whereas extracranial growth of meningiomas has been rarely reported. We herein report a rare case of a giant malignant meningioma with multiple recurrences. A 56-year old man presented with a forehead swelling. He had a history of repeated craniotomy for a frontal sinus invasion. The tumor recurred one year after the last surgery on the forehead and was classified as a giant meningioma at admission to our hospital. Neurosurgeons performed total resection of the giant meningioma and reconstructed the defect. However, six months after the surgery, the tumor recurred at the same site. The patient refused surgery and underwent cyber-knife treatment. An hydroxyurea treatment was initiated after radiotherapy, but the tumor progressed. Temozolomide and cisplatin treatment was started. A valuable clinical improvement was observed after the initiation of the first cycle. After completion of two cycles of systemic chemotherapy, the patient will be assessed clinically and radiologically.