MFH is one of the most common soft tissue sarcomas in adults [
3,
4]. The most common sites of origin are the proximal extremities, particularly the thigh and buttock [
4]. This tumor presents as a multilobular fleshy mass, often apparently circumscribed, although the microscopic growth pattern is frequently infiltrative among fascial planes and between muscle fibers, accounting for its high rate of local recurrence [
5]. Four established subtypes have been described, each with similar prognostic features. The most common variant is the storiform pleomorphic type, which comprises spindle cells in a storiform pattern, plump histiocyte-like cells and pleomorphic multinucleated giant cells [
6,
7]. The prognosis of MFH is generally poor [
8]. Definitive treatment is surgical, either with wide local excision or total resection. An MFH occurring on the scalp is extremely rare, and one accompanied by intracranial stroke is even rarer [
9,
10]. In our case, our patient was an elderly man with no immediate relevant medical history and no prior radiation exposure, but he did have a history of an anterior communicating artery aneurysm clipping operation. A subcutaneous tumor was seen on the right side of his forehead at the original incision site. Dissection of his temporal muscle tissue and deep fascia using electric resection and electrocoagulation through the pterional approach may have resulted in tissue degeneration, which in turn might have led to the cancer. The reason for the development of this tumor five years after the aneurysm operation was unclear. It is possible that the tumor was a primary MFH of the scalp. Our patient was followed-up for two years without recurrence. Because MFH of the scalp has a high degree of malignancy and easily recurs
in situ, early diagnosis and radical surgical resection are key to a successful outcome [
11,
12].