Scalp Swelling Caused by Extracranial Extension of Meningioma

Head lumps are a common presentation in clinical practice and, in most cases, are benign and require no further investigation.However, rarer and potentially serious pathologies should be considered, particularly when a scalp lesion is associated with new neurological symptoms.We report an unusual case of an intracranial meningioma with extensive calvarial involvement and extracranial extension presenting as a longstanding scalp lump.A 45-year-old man presented to hospital following an episode of collapse associated with jerky movements, raising suspicion of a seizure.He had a longstanding, asymptomatic scalp lump that had been present for 18 years.Neuroimaging revealed a parasagittal meningioma with extensive involvement of the calvarium and transcalvarial extension into the scalp.The patient underwent surgical excision of the meningioma along with craniectomy and primary titanium cranioplasty, with histopathology confirming a World Health Organization (WHO) grade 1 meningioma.He made a good postoperative recovery and remained seizurefree at the one-year follow-up.Although most head lumps are benign, this case highlights the importance of maintaining a broad differential diagnosis, particularly when a longstanding lesion is associated with new neurological symptoms.Meningiomas with extracranial extension are rare but should be considered in patients presenting with a scalp mass and an underlying calvarial abnormality.Timely imaging and appropriate neurosurgical management can facilitate diagnosis and treatment and may result in favorable neurological outcomes.