A recurrent meningothelial meningioma within a fascial dural graft with increased proliferative activity

Background: The standard surgical treatment for meningiomas is gross total resection of the tumor with the involved dura mater, followed by dural reconstruction using either an artificial dural substitute or autologous fascia. Nevertheless, recurrence may occur even after gross total resection, most commonly owing to microscopic residual tumor cells at the dural margins or within the adjacent bone. Conversely, recurrence within the reconstructed dura itself is exceedingly rare. Case Description: A 63-year-old man visited our hospital because of progressive disorientation. Magnetic resonance imaging (MRI) revealed a cyst-associated extra-axial tumor in the right temporal region accompanied by extensive cerebral edema. Gross total resection was achieved, and the dura was reconstructed using Gore-Tex. Histopathological examination revealed a meningothelial meningioma with a low proliferative index (Ki-67 labeling index, 2%). One month postoperatively, a surgical site infection necessitated removal of the dural substitute and bone flap, followed by duraplasty using autologous fascia lata. Twenty months after the initial surgery, MRI demonstrated tumor recurrence arising within the fascia lata graft. The recurrent tumor and fascial graft were resected en bloc in the second surgery. Histopathological analysis demonstrated tumor infiltration into the fascial graft and a markedly increased proliferative index (Ki-67 labeling index, 15%), indicating increased proliferative activity compared with the initial tumor. Conclusion: This case highlights the possibility of meningioma recurrence within an autologous fascial graft used for dural reconstruction, suggesting that the reconstructed dural graft may serve as a potential substrate for tumor growth. Careful long-term radiological surveillance should therefore be considered following meningioma resection.