{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T14:12:46Z","timestamp":1788876766274,"version":"build-2803163510"},"reference-count":16,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Meningiomas, the most common primary intracranial tumours (accounting for 36% of central nervous system neoplasms), typically present as well-circumscribed, extra-axial masses with homogeneous enhancement, dural tails and hyperostosis on imaging. However, 15% show atypical features that can mimic gliomas, metastases or abscesses, posing diagnostic challenges. This case series present seven histologically confirmed meningiomas illustrating atypical imaging appearances, identified retrospectively from the institutional teaching archive. The cases include intraventricular, septated cystic, perineural spread, circumscribed low T2 or FLAIR signal, frond-like low T2 or FLAIR signal, peritumoural cystic and radiation-induced meningiomas. All were WHO grade 1, except one radiation-induced grade 2 tumour. Key atypical imaging findings included heterogeneous enhancement, non-suppressing cystic components on FLAIR, brain invasion, absent dural tail and perilesional oedema. Although these features suggested higher-grade behaviour, they did not correlate with the final histological grade. Atypical imaging features in meningiomas may closely mimic more aggressive pathologies and do not reliably predict histological grade. Recognition of these variants is essential for accurate diagnosis and appropriate management.\nContribution:\u00a0This case series expands the recognised imaging spectrum of meningiomas by demonstrating diverse atypical appearances that closely mimic other intracranial pathologies. Importantly, it highlights the discordance between aggressive imaging features and histological grade, reinforcing that atypical morphology should not be equated with higher-grade disease.<\/jats:p>","DOI":"10.4102\/sajr.v30i1.3480","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T14:03:46Z","timestamp":1788876226000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Unusual presentations of meningiomas: A case series"],"prefix":"10.4102","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6263-3294","authenticated-orcid":false,"given":"Tavonga P.C.S.","family":"Bayela","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05bk57929","id-type":"ROR","asserted-by":"publisher"}],"name":"Stellenbosch University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4598-1127","authenticated-orcid":false,"given":"Christell","family":"Ackermann","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05bk57929","id-type":"ROR","asserted-by":"publisher"}],"name":"Stellenbosch University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8030-7444","authenticated-orcid":false,"given":"Morn\u00e9 D.","family":"Coetzee","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05bk57929","id-type":"ROR","asserted-by":"publisher"}],"name":"Stellenbosch University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0155-485X","authenticated-orcid":false,"given":"Suzanne","family":"O\u2019Hagan","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05bk57929","id-type":"ROR","asserted-by":"publisher"}],"name":"Stellenbosch University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Ogasawara C, Philbrick BD, Adamson DC. Meningioma: A review of epidemiology, pathology, diagnosis, treatment, and future directions. Biomedicines. 2021; 9(3):319. https:\/\/doi.org\/10.3390\/biomedicines9030319","DOI":"10.3390\/biomedicines9030319"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Torp SH, Solheim O, Skjulsvik AJ. The WHO 2021 classification of central nervous system tumours: A practical update on what neurosurgeons need to know \u2013 A minireview. Acta Neurochir (Wien). 2022;164(9):2453\u20132464. https:\/\/doi.org\/10.1007\/s00701-022-05301-y","DOI":"10.1007\/s00701-022-05301-y"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Louis DN, Perry A, Wesseling P, et al. The 2021 WHO classification of tumors of the central nervous system: A summary. Neuro Oncol. 2021;23(8):1231\u20131251. https:\/\/doi.org\/10.1093\/neuonc\/noab106","DOI":"10.1093\/neuonc\/noab106"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Rogers L, Barani I, Chamberlain M, et al. 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