Cervical vertebral metastases from a recurrent intracranial anaplastic meningioma: illustrative case.

backgroundMeningiomas represent the most prevalent primary tumors of the central nervous system, with the majority classified as benign (WHO grade I) and exhibiting favorable prognoses. However, a rare subset of meningiomas show malignant behavior, characterized by local invasion and distant metastasis, occurring in less than 1% of cases. Metastatic meningiomas most commonly involve the lungs, bones, liver, and soft tissues, with bone metastases presenting significant diagnostic and therapeutic challenges. OBSERVATIONS: A 61-year-old male with a history of recurrent intracranial meningiomas presented with neck pain and digital paresthesia. Imaging studies revealed lesions at the C4 and C5 vertebrae, accompanied by a pathological fracture at C5. Consequently, a C4 and C5 corpectomy with anterior reconstruction was performed. Histomolecular analysis confirmed the presence of an intraosseous anaplastic meningioma. LESSONS: Metastatic meningiomas are an uncommon entity that necessitates a multidisciplinary approach for accurate detection and effective management. The integration of molecular and genetic profiling, along with advanced imaging techniques, may facilitate the identification of high-risk tumors, guide personalized treatment strategies, and ultimately improve patient outcomes. https://thejns.org/doi/10.3171/CASE24863.