Secondary Reconstruction of Recurrent Primary Intraosseous Meningioma of the Calvarium Using a Fasciocutaneous Anterolateral Thigh Free Flap

We present a patient with a primary intraosseous meningioma of the calvarium that recurred three years after initial resection and reconstruction with a free anterolateral thigh (ALT) flap. The patient re-presented with progressive swelling in the same area. Imaging confirmed aggressive tumour recurrence with both intra- and extra-cranial diseases and also extension to the ipsilateral orbit. The original anterolateral free flap was raised on anterior pedicle and further debulking of the tumour was performed. Histology confirmed widely infiltrative atypical meningioma (WHO grade II). This case highlights the benefit of using a fasciocutaneous free flap for reconstruction given the potential for tumour recurrence.