# Case report: preoperative radiological suspicion of atypical meningioma: A diagnostic challenge

## TL;DR

This case report highlights the challenges in diagnosing an atypical meningioma using MRI before surgery.

## Contribution

The report emphasizes the importance of advanced MRI techniques in preoperative identification of atypical meningiomas.

## Key findings

- MRI features like cystic components and heterogeneous enhancement suggested an atypical meningioma.
- Histopathological analysis confirmed the preoperative MRI suspicion of atypical meningioma.
- Comprehensive MRI aids in surgical planning and decisions about adjuvant therapy.

## Abstract

Atypical meningiomas represent a minority of intracranial meningiomas yet carry more aggressive biological behavior and higher recurrence rates, making preoperative differentiation essential for optimal management. We report a 56-year-old female presenting with progressive headaches, drowsiness, and vomiting, with no focal neurological deficits. Brain Magnetic Resonance Imaging (MRI) revealed a dural-based lesion at the posterior falx with cystic components, irregular margins, heterogeneous enhancement, disproportionate peritumoral edema, all suggesting atypicality. Subtotal resection followed by histopathological analysis confirmed a atypical meningioma. This case underscores the pivotal role of comprehensive MRI—including conventional sequences and advanced techniques—in identifying features of atypical meningioma even without definitive brain invasion, thereby guiding appropriate surgical planning and consideration of adjuvant therapy.