MKI67 and meningioma: This case is of particular significance due to two key factors: (1) it is amongst the few reported instances of a purely epidural meningioma and the first to exhibit an atypically elevated Ki-67 index (>4%) despite being classified as WHO Grade I, raising questions about its biological behavior, and (2) it adds to the growing body of evidence suggesting a potential link between hormonal factors and meningioma development, especially in patients with a history of gynecologic malignancies.