{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T11:10:28Z","timestamp":1778238628584,"version":"3.51.4"},"reference-count":16,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Case Description:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.25259\/sni_48_2026","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T10:33:38Z","timestamp":1778236418000},"page":"266","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["An intra-axial wolf in extra-axial clothing: A rare case of high-grade astrocytoma and literature review"],"prefix":"10.25259","volume":"17","author":[{"given":"Talha","family":"Sajid","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad 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