Atypical presentation of a large posterior falx meningioma involving the parafalcine region in a 78-year-female: A case report.

Abstract

Background: Meningiomas represent the most common primary intracranial tumor in adults. The majority of meningiomas are indolent, benign, and sporadic in nature. The incidence of meningiomas is directly proportional to the age, peaking around 65 years. The presenting symptomatology of intracranial meningiomas is mainly dependent on their anatomical location, as with the majority of brain tumors. Surgical resection and radiation therapy remain the treatment modality for meningiomas of all grades.

Case summary: We present a case describing a 78-year-old female who came in following a ground level fall. The primary assessment was notable for a history of similar recurrent falls and subtle left-sided peripheral visual field loss. Further neurological examination was otherwise largely unremarkable. A computed tomography scan of the head revealed a large extra-axial mass located along the posterior aspect of the falx. Follow-up magnetic resonance imaging confirmed a lesion measuring around 6.6 cm × 4.2 cm × 5.5 cm. A partial surgical resection of the right-sided portion of the lesion was performed. Complete resection was limited by insufficient visualization and challenges with hemostatic control of the left parafalcine region. Further histopathological analysis confirmed a fibrous meningioma with focal necrosis, consistent with World Health Organization Grade 2 classification. She was subsequently scheduled for outpatient follow-up to assess the residual tumor management.

Conclusion: This case highlights the importance of maintaining a high index of suspicion for intracranial pathology in elderly patients with nonspecific presentation.