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

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.