Dural-Based Glioblastoma Recurrence: An Illustrative Case and Review of Literature.

Glioblastoma is a common primary central nervous system tumor with an expected median overall survival of 12 to 15 months. Radiographically, high-grade gliomas classically present as heterogeneous ring-enhancing lesions in the brain parenchyma with central necrosis on MRI. In rare cases, other peripheral tumors can also present with a meningeal attachment with evidence of a dural tail. Histologically, the tumor has malignant features such as atypical cells, nuclear hyperchromasia, increased mitotic figures, angiogenesis, and necrotic regions. We present a 49-year-old male with a history of a left frontotemporal glioblastoma isocitrate dehydrogenase (IDH) wild type and O6-methylguanine-DNA methyltransferase (MGMT) unmethylated (~ 95% of gross total). The patient subsequently underwent chemotherapy with temozolomide and external beam radiation therapy with 60 Gy over 30 fractions. The patient presented eight months post-index resection with recurrence and dural invasion. The pathology report demonstrated adherent dural components. The patient was subsequently placed on bevacizumab. There is a paucity of literature regarding dural-based spread of glioblastoma along the dura after an initial resection. Additionally, there is difficulty in differentiating these tumors from meningiomas, with resultant misdiagnosis and management. It is critical to inform readers of its presence and emphasize the importance of its consideration in the differential diagnosis of dural-based tumors.