**8. Anaplastic or malignant meningiomas or WHO grade III**

Anaplastic meningiomas may present directly as primary tumors or may derive from a malignant transformation of less aggressive lesions. Malignant meningiomas are character‐ ized by the following [4]:


Papillary meningiomas are rare and commonly found in children, characterized by a pseudo‐ papillary architecture. Rhabdoid meningiomas are formed by cells with eccentric nuclei and paranuclear inclusions.

Anaplastic meningiomas are associated with a high risk of recurrence and distant metasta‐ ses. The most common sites of extraneural metastases are the liver, lungs, pleura, and lymph nodes.

Surgery aiming to obtain gross total or near total surgical resection represents the first choice, and it is combined with different types of external beam radiotherapy (fractionated or stereotactic radiosurgery) [47, 48] Anaplastic meningiomas are malignant tumors with a survival limited to 1.5–3.5 years according to most of the series [49]. A better overall survival was observed in cases <60 years old and in patients receiving adjuvant radiotherapy [46]. The role of chemotherapic agents is still under investigation, and the debate is open in particular for somatostatine analogues [50, 51].
