We report four new cases of meningeal Solitary Fibrous Tumour (SFT). Two pa
tients presented with raised intracranial pressure from posterior fossa SFT
, and the third developed hemiparesis and dysphasia due to a large lesion t
hat originated in the left middle cranial fossa. These were successfully ex
cised and the patients remain well at follow-up of between 1 and 3 years. T
he fourth patient, a 71-year-old man, suffered an intracerebral haemorrhage
and later died from a malignant SFT that had invaded the falx cerebri, sup
erior sagittal sinus, and brain. This is the first description of a locally
aggressive meningeal SFT with multiple atypical histological features.
The 31 previously reported cases of meningeal SFT are reviewed. They occur
at all ages and may be relatively more common in the posterior fossa and sp
ine. Intracranial SFT originate from the dura and are probably indistinguis
hable from meningiomas on imaging and at surgery. In contrast, approximatel
y two-thirds of spinal SFT have no dural attachment. Histologically, SFT ar
e spindle-cell neoplasms with a characteristic immunohistochemical profile
of CD34, vimentin, and bcl-2 positivity. Data on outcome for patients with
meningeal SFT are limited. At other sites, however, extent of resection is
the most important prognostic factor, and invasion or metastasis can occur
with histologically benign SFT. Meningeal SFT should, therefore, be excised
as completely as possible and followed carefully in the long-term.