Meningioma is a common intracranial tumor, and most have good outcomes after surgical resection. However, there are some meningiomas that are not only prone to local recurrence within the skull after surgical resection or even adjuvant radiation therapy, but may also metastasize to other organs and tissues outside the brain, with the most common site of meningioma metastasis being the lungs. Distant metastases from meningiomas are often found with tumor recurrence and generally occur in non-benign meningiomas. A recent case of a 55-year-old man with an atypical meningioma was diagnosed as “atypical meningioma” after two craniotomies to remove the intracranial meningioma 9 years and 4 years ago, respectively. This time, the tumor was found to have recurred in the brain again due to impaired limb movement, with one tumor in its original location and the other in a more distant location, but both intracranially. However, multiple nodules were also found in the lungs at the same time, but no metastatic lesions were found in other parts of the body. In response to this situation of intracranial recurrence and extracranial distant metastasis at the same time, we first removed both tumors from the brain at one time by craniotomy, and the pathological diagnosis was the same as the original surgical pathological diagnosis, both were atypical meningiomas. About 3 weeks after the brain surgery, the patient had the largest pulmonary nodule removed thoracoscopically in the thoracic department, and the pathological diagnosis was also atypical meningioma. Atypical meningiomas are WHO grade II meningiomas and may be accompanied by advanced recurrence along with multiple extracranial metastases, most commonly in the lungs. Malignant mesenchymal meningiomas are more likely to have distant metastases. Recently, there was another 56-year-old male patient who also underwent three surgeries to remove meningioma from his brain 4 years, 1 year and 6 months ago respectively due to its large size, and also underwent general radiotherapy and gamma knife treatment when the tumor recurred in the interim, and the tumor was found to have recurred intracranially again 1 month ago due to impaired limb movement. The preoperative MRI showed that one of the recurrent tumors was located near the original tumor resection site and the other larger tumor was located next to the original tumor site due to implantation spread. Mesenchymal meningioma is a WHO grade III malignant meningioma, which can develop distant metastases to the lungs, not only in the form of multiple pulmonary metastatic meningioma lesions, but also in the form of a single isolated metastatic lesion. It is not uncommon for meningiomas to develop metastases, typically seen in non-benign WHO grade II and WHO grade III meningiomas, and often found with recurrence of the tumor. Metastases outside the brain are most commonly found in the lungs, but can also occur in other organs and sites such as the liver. For follow-up of malignant meningioma, it is important to pay attention not only to the local recurrence of the tumor, but also to be alert for the occurrence of metastases to distant organs outside the brain.