Glioblastoma multiforme (GBM) is one of the most aggressive primary intracerebral tumors. This type of neoplasm can rarely present as a mass with meningeal attachment and radiographic evidence of a dural tail, which was until recently thought to be specific to meningiomas.

We present a rare case series of glioblastoma multiforme (GBM) with meningeal attachments and radiographic appearances of dural tails. Our observations suggests that such findings on imaging may serve as good prognostic indicators for this otherwise rapidly fatal condition.

History, physical exam, review of literature.

We discuss a case series and review of the literature, which includes a 63 yo male who presented to the emergency room with a 2-week history of falls and new-onset seizures. MRI brain with gadolinium contrast confirmed a large, heterogeneously enhancing mass with evidence of central necrosis. There was a broad attachment with a “dural tail” feature. During the craniotomy, the mass was noted to have a grey, firm consistency, which directly extended into the overlying dura. Final pathology revealed a WHO grade IV astrocytoma with meningeal invasion. Recovery after surgery was uncomplicated, and he was discharged on post-operative day five. Twelve months after diagnosis, the patient was doing well neurologically with a stable disease burden on follow-up MRI.

Of the 7 patients in our case series who presented with rare GBMs with dural tails, 5/7 had favorable outcomes including good neurological functioning for more than 2 years on follow-up. This is significant since the median age of survival is between 6-12 months and only 6.4% of GBM patients typically survive longer than 2 years.

Our case series represents important additions to the rare finding of extracranial GBMs presenting with dural tails. We demonstrate compelling evidence that suggests these radiographic findings may serve as favorable prognostic indicators for this otherwise extremely aggressive condition.