Recurrent Angiomatous Meningioma in a Young Adult: A Case Report

BACKGROUND Meningiomas stand as the predominant primary intracranial tumors, encompassing a broad spectrum of histological variations. Within this spectrum, angiomatous meningiomas are notable for their significant vascularity within the tumor structure and rarity, making up only 2.1% of all meningiomas. These tumors typically present with slow-onset symptoms, commonly manifesting as seizures and compression-related effects. This report describes a 27-year-old man presenting with seizures and a diagnosis of angiomatous meningioma with postoperative recurrence, emphasizing the challenges in imaging, diagnosis, and disease management. CASE REPORT A 27-year-old man presented with a generalized seizure and unconsciousness. He had a history of exposure to chemicals from road construction and logging and smoked for 7 pack years. Initial CT scan revealed a 2.8-cm irregular tumor on the convex surface of his right frontal lobe. Craniotomy and resection of the lesion revealed angiomatous meningioma (central nervous system [CNS] World Health Organization [WHO] grade I). Six months later, control MRI showed recurrence at the excision site (2.4×2.0×1.4 cm). Re-craniotomy confirmed atypical meningioma (CNS WHO grade 2), and the patient received postoperative radiotherapy (56 Gy). CONCLUSIONS This case report highlights the importance of MRI in diagnosing angiomatous meningioma, a rare subtype comprising only 2.1% of all meningiomas. Although the tumor was initially resected successfully, its rapid recurrence as a WHO grade 2 atypical meningioma within 6 months underscores the surgical challenges and high recurrence risk associated with its vascular nature. These findings emphasize the need for careful postoperative monitoring and management.