Appendicular metastasis from WHO grade II meningioma ten years after craniotomy: a case report and literature review

Extracranial metastases from meningioma are exceedingly rare, representing <1% of all cases, with appendicular skeletal involvement being exceptional. We report a 51-year-old woman who developed a destructive iliac bone lesion ten years after complete resection of a WHO Grade II (atypical) parietal meningioma. Computed-tomography-guided biopsy confirmed metastatic meningioma morphologically identical to the original tumor. A systematic review (1959-2024) identified 26 reported cases of appendicular skeletal metastases, most frequently involving the femur and iliac bone, with a mean latency of 8.9 years. These findings emphasize the indolent yet unpredictable metastatic potential of atypical meningiomas and highlight the importance of lifelong surveillance, as metastasis should be considered even after prolonged disease-free intervals.