A rare case of posttraumatic subdural hematoma and intratumoral hemorrhage in a left frontotemporal meningioma: a conservative approach with longitudinal follow-up. Illustrative case.

backgroundMeningiomas are common primary intracranial tumors, with associated intratumoral hemorrhage being a rare but serious complication requiring prompt diagnosis for optimal outcomes. Although spontaneous bleeding in benign meningiomas is rare, it can lead to subarachnoid hemorrhage, subdural hematoma, or intratumoral/intracerebral hemorrhage, significantly increasing morbidity and mortality. Advanced imaging and recognition of radiographic hemorrhage patterns are crucial for accurate diagnosis. Treatment is case specific, as surgical intervention is preferred for symptomatic patients, while observation might be adequate for asymptomatic cases. When surgery is not feasible, stereotactic radiotherapy or chemotherapy, which is used only as salvage therapy, is considered. OBSERVATIONS: The authors present the case of a 78-year-old male with a history of recurrent falls. Imaging studies revealed a posttraumatic subdural hematoma and an intratumoral hemorrhage within a left frontotemporal meningioma. The patient was managed conservatively, showing significant improvement over 6 months. Notably, there was a marked reduction in both tumor size and intratumoral hemorrhage during follow-up. LESSONS: This case highlights the importance of adopting case-specific management strategies for hemorrhagic complications associated with meningiomas. While surgery is crucial for symptomatic meningiomas, this case demonstrates that conservative methods can be effective for a subset of symptomatic patients with stable clinical conditions and manageable intracranial bleeding. https://thejns.org/doi/10.3171/CASE24322.