Late surgical site hemorrhage is a possible radiologic indicator of early tumor recurrence in grossly totally resected high-grade meningioma: A case report

Rhabdoid meningioma is a rare high-grade tumor that tends to recur with the potential for extracranial metastasis. The primary treatment is surgery, if feasible, with adjuvant radiotherapy. We present a case of a 27-year-old male patient who presented with symptoms of increased intracranial pressure. Imaging revealed a large heterogeneously enhancing mass in the right frontal lobe surrounded by moderate vasogenic edema, causing significant midline shift. The patient underwent gross total resection with uneventful postoperative recovery. Histopathology confirmed rhabdoid meningioma, classified as World Health Organization grade III. The patient received adjuvant radiotherapy with no significant adverse events. After 6 months of surgery, he started to complain of headache. His brain magnetic resonance imaging showed an extra-axial hematoma at the surgical site with no associated enhancing soft tissue component that progressively increased in size on subsequent scans, along with intraparenchymal extension into the right frontal lobe, not causing midline shift or brain herniation. The hematoma was not explained by any trauma or medical causes. In addition, lung and bone metastases were evident 8 months post-surgery. Unfortunately, this rapid deterioration led to the patient’s death. Despite the emphasis of gross total resection as the most important factor for tumor control, high-grade meningiomas pose a therapeutic challenge due to their aggressive nature. Late intracranial bleeding (>3 months) in the absence of possible contributing factors should raise suspicion of tumor recurrence as early detection can improve patient’s prognosis. Moreover, frequent close follow-up and molecular testing should be further investigated to improve patient outcomes, especially in the younger age group.