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Arteriovenous malformations (AVM) in the scalp are infrequent vascular lesions. Its clinical presentation varies from annoying and unaesthetic mass of the skin to devastating hemorrhages. Its origin can be congenital or traumatic. The diagnosis of AVM is based on physical examination and confirmed by internal and external carotid angiography. Nowadays the gold standard treatment is the surgical intervention although the endovascular approach is gaining field in order to reduce blood losses as presurgical or like lonely treatment. A 50 year old woman was admitted with a huge mass in scalp, with subcutaneous enlarged vessels and no other symptoms. A head traumatic antecedent had occurred 12 years before. The angiography evidenced a mottled AVM with blood supplies from the external and internal carotid arteries, with meningeal transosseous branches from both ophthalmic arteries. Endovascular treatment could not be performed due to high risk of uni or bilateral amaurosis. Thus, a conventional surgical treatment was done without complications. The treatment of AVM of scalp offers various possibilities but the individualization of each case becomes essential to decide the correct management in order to avoid complications.

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SummaryObjective. Malignant intraventricular meningiomas are very rare. To the best of our knowledge, only eleven cases have been reported thus far. Seven of them developed cerebrospinal fluid (CSF) metastases. We present herein the first case of a malignant intraventricular meningioma with extraneural metastases.Clinical presentation. We report a 44 year-old-man with a history of progressive headache and disorientation. Magnetic resonance imaging (MRI) revealed a 5-cm homogeneously-enhancing mass in the right trigone.Intervention. The lesion was totally resected via a parietooccipital transcortical approach. Histological examination demonstrated an atypical meningioma. Thereafter, the tumor recurred twice. At first recurrence, the tumor was completely removed again and external radiotherapy was administered. At surgery at second recurrence, the tumor was more aggressive, invading the brain parenchyma. Histological examination showed anaplastic meningioma. The patient was readmitted to hospital with fever and pain in right hypochondrium. Abdominal ultrasound examination disclosed multiple hypoechoic liver lesions. Biopsy was consistent with liver metastases of a malignant meningioma. The patient died of acute liver failure seven months after initial diagnosis.Conclusion. Malignant intraventricular meningiomas are prone to recur and develop metastases, mainly through the CSF. Nevertheless, our case shows that extraneural metastases are also possible. Therefore, when systemic deterioration occurs in a patient with a malignant intraventricular meningioma, metastases to extraneural organs such as the liver must be ruled out.KEY WORDS: Intraventricular malignant meningioma. Acute liver failure. Anaplastic. Extraneural dissemination. Intraventricular meningioma. Liver metastases. Transformación anaplásica de un meningioma atípico intraventricular con metástasis hepáticas: caso clínico ResumenObjetivos. Los meningiomas malignos intraventriculares son muy infrecuentes. En la bibliografía existente sólo se han descrito once casos hasta ahora. Siete de ellos desarrollaron metástasis a través del líquido cefalorraquídeo (LCR). Presentamos el primer caso de un meningioma maligno intraventricular con metásta-sis extraneurales.Caso clínico. Paciente varón de 44 años de edad con una clínica de cefalea progresiva y desorientación. La resonancia magnética mostraba un proceso expansivo intracraneal en el trígono derecho con captación de contraste de forma homogénea.Intervención. Se practicó una resección total de la lesión a través de un acceso transcortical. El análisis histológico mostró un meningioma atípico. A pesar de la resección total, el tumor recidivó otras dos veces. Después de la primera recidiva, el tumor fue extirpado nuevamente y el paciente recibió radioterapia externa. En la segunda recidiva, el tumor se comportó de forma más agresiva, invadiendo el parénquima cerebral. El análisis histológico mostraba un meningioma anaplásico. El paciente fue ingresado nuevamente por fiebre y dolor en el hipocondrio derecho. Una ...