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The patient was very hesitant to have surgery but settled for receiving radiation. Seven months after radiation, he presented with a decreased level of consciousness and skin necrosis with maggot infestation. His code status was changed to "do not attempt resuscitation," and he died 3 days later in December 2019. Large intracranial meningiomas with massive transosseous extension to the scalp pose a significant challenge to the treating team. Proper planning and a multidisciplinary approach are essential. However, prognosis remains gener