{"id":"6aa48f11-ae84-4acf-9383-7388357403a0","slug":"an-intra-axial-wolf-in-extra-axial-clothing-a-rare-case-of-high-grade-astrocytoma-and-literature-review","title":"An intra-axial wolf in extra-axial clothing: A rare case of high-grade astrocytoma and literature review","authors":["Talha Sajid","Muhammad Arslan Iqbal","Khawar Zaman","Salman Ahmed","Umer Farooq Raina"],"abstract":"Background: High-grade astrocytomas are typically intra-axial, diffusely infiltrating brain tumors. Their presentation as a primary dural-based, extra-axial mass mimicking an aggressive meningioma is exceptionally rare, creating a significant diagnostic challenge and potential for preoperative misdiagnosis. Case Description: A 40-year-old male presented with a 2.5-year history of headache and vertigo, followed by generalized seizures. Neurological examination revealed bilateral papilledema with subtle right-sided upper motor neuron signs. Imaging revealed a large, heterogeneously enhancing, left fronto-temporo-parietal mass with broad dural attachment, calvarial erosion, and mass effect, but notably minimal perilesional edema. The primary radiological differential diagnoses included atypical meningioma, dural-based lymphoma, and metastasis. Following maximal safe resection, histopathological and molecular analysis confirmed the diagnosis of an astrocytoma, isocitrate dehydrogenase (IDH)-mutant, central nervous system World Health Organization grade 4. The patient received adjuvant focal radiotherapy (59.4 Gy in 33 fractions) and at 6-month follow-up was neurologically stable, seizure-free, and demonstrated marked radiological regression. Conclusion: This case highlights that high-grade astrocytoma, including IDH-mutant variants, can present with classic extra-axial and meningioma-like imaging features. It underscores the critical importance of definitive histomolecular diagnosis over radiographic impression alone to guide appropriate, biology-directed management. The patient demonstrated an encouraging early clinical and radiological response following surgical resection and radiotherapy.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/6aa48f11-ae84-4acf-9383-7388357403a0/featured/hero-1781557550101.png","publishDate":"2026-05-08T00:00:00.000Z","doi":"10.25259/SNI_48_2026","categories":["Neuro-oncology","Case Report"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/6aa48f11-ae84-4acf-9383-7388357403a0/pdf"}