A Rare Recurrent Intracranial Meningioma with Variable Histopathological Grades and Pulmonary Metastasis: A Case Report.

Meningiomas are predominantly benign intracranial neoplasms, with extracranial distant metastasis occurring in fewer than 1% of all patients; pulmonary metastasis represents an exceedingly rare complication of meningioma progression and recurrence. We describe a 44-year-old male patient with sequentially recurrent intracranial meningioma exhibiting dynamic histopathological grade evolution combined with synchronous bilateral pulmonary metastatic lesions, followed for an unprecedented 18 clinical years. Across follow-up, the patient received four open craniotomies, two sessions of stereotactic Gamma Knife radiosurgery, a CT-guided percutaneous lung biopsy, and minimally invasive pulmonary radiofrequency ablation. Post-intervention serial neurological and radiological monitoring documented favorable functional recovery: final Glasgow Coma Scale (GCS) = 15 and Modified Rankin Scale (mRS) = 1 at latest follow-up, with complete resolution of initial left lower limb weakness and stable control of both intracranial residual sinus-associated tumor and all pulmonary metastatic nodules without newly emerging systemic metastasis. This long-duration real-world clinical cohort highlights the critical necessity of full-body systemic imaging screening and lifelong standardized periodic surveillance for meningiomas with superior sagittal sinus invasion and progressive pathological upgrading, to facilitate early identification of occult distant pulmonary metastasis and formulate individualized combined surgical-radiation-ablation treatment regimens for high-risk recurrent meningioma.