Giant calvarial solitary fibrous tumor with intracranial and extracranial extension in an elderly patient: imaging and surgical considerations

Solitary fibrous tumors (SFTs) are rare hypervascular mesenchymal tumors that may occasionally involve the calvarium with both intracranial and extracranial extension. We report the case of an 87-year-old hypertensive woman who presented with progressive right-sided weakness and worsening headache associated with a large left parietal scalp mass. Contrast-enhanced CT and MRI demonstrated a giant left parietal calvarial lesion with heterogeneous enhancement and extensive intra- and extracranial components causing mass effect with midline shift. Preoperative imaging suggested a hypervascular skull lesion, and surgical en bloc resection was performed with removal of involved bone. Histopathological examination confirmed a spindle-cell neoplasm with staghorn vascular pattern, nuclear atypia, and bone involvement, consistent with solitary fibrous tumor. The patient had an uneventful postoperative recovery with clinical improvement. This case highlights the importance of imaging in characterizing calvarial masses and guiding surgical planning and management.