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Hemorrhagic angiomatous meningioma: what we know. Case report and review of the literature

Meningiomas are the most common benign intracranial tumors and rarely present with spontaneous bleeding. We report on a case of hemorrhagic angiomatous meningioma that was treated surgically (the first case described in Brazil) and present a review of the literature. The patient wasa 38-year-old female with progressive headache and vomiting. She also had a previous history ofchronic headaches and refractory depression. Imaging studies showed a large left frontal extra-axialtumor, with intense contrast enhancement and hyperperfusion/hypervascularization. There was anextensive intratumoral and pericapsular hemorrhagic region, with dilation of the middle meningealarteries and falx cerebri vessels. The lesion was compatible with hemorrhagic meningioma. Thepatient underwent bifrontal craniotomy and tumor devascularization, followed by total resection.Histopathological and immunohistochemical analyses led us to conclude that this was a case of angiomatous meningioma. Subsequently, the patient’s headaches and depression improved. Noresidual or recurrent neoplastic lesion was observed during the follow-up.