Abstract
BACKGROUND: Meningiomas are the most common primary intracranial tumors, accounting for approximately one-third of all primary brain neoplasms, typically characterized by a single histological variant. Multiple meningiomas are a relatively rare occurrence in a single patient, particularly when exhibiting different histopathological variants. OBSERVATIONS: The authors present the cases of three patients, each with two separate intracranial meningiomas of different variants. One patient had secretory and angiomatous meningiomas, while two patients had transitional and psammomatous meningiomas. LESSONS: Studies of multiple meningiomas, especially cases like those in this report with different subtypes, will highlight how genetic mutations correlate with tumor location, histology, and possible clonal origins. Certain mutations, such as TRAF7 and KLF4, are linked to secretory meningiomas, while others like neurofibromatosis type 2 are associated with specific locations and fibrous histology. The presence of mutually exclusive mutations suggests that different meningiomas can either arise independently or share a common progenitor cell with divergent mutations. Comparing genetic profiles of multiple meningiomas in a single patient can clarify tumor pathogenesis and support the development of targeted therapies, aiding in personalized treatment strategies and improving outcomes. https://thejns.org/doi/10.3171/CASE24359.