Meningioma is a common intracranial neoplasm derived from meningothelial cells. Meningiomas are associated with a benign clinical course. However, malignant behaviour such as metastatic disease has been also described. Our aim was to analyze the metastatic pattern taking tumor grading into consideration, and to determine clinical signs of distant metastases in meningiomas. In this systematic review PubMed database was screened for distant meningioma metastases from 1990 to 2012. 95 articles were identified. Only cases with metastasized meningiomas were included in the analysis. Our analysis comprised 115 cases with 164 metastatic lesions. Primary tumors were in 33.9 % grade 1, 20.9 % grade 2, and 40 % grade 3. In 5.2 % the grade was not reported. In 93 % meningiomas were diagnosed and resected before distant metastases occurred. In 6.1 % metastases were identified simultaneously with primary tumors and in 0.9 % metastases were identified before the primary tumor was found. The metastatic lesions were localized most frequently in the lung (37.2 %), bones (16.5 %), intraspinally (15.2 %), and in the liver (9.2 %). Other locations were rarer. The size of the metastases varied from 0.6 to 28 cm (median size, 3 cm). There were no significant differences between sizes of the identified metastases in relation to tumor grading. 50.4 % of distant metastases were clinically manifest and 31.3 % were identified incidentally. In 18.3 % clinical signs were missing. In our review 31.3 % of metastatic meningiomas were found to be clinically silent. The prevalence of metastases in meningioma may be underreported.

Objective:To describe the technique for surgical tumor removal, cochlear implant (CI) electrode placement and reconstruction of the surgical defect in patients with intracochlear schwannomas.Study Design:Retrospective case review.Setting:Tertiary referral center.Patients:Ten patients (five men, five women, mean age 48 ± 12 yr) with profound or severe to profound hearing loss due to intralabyrinthine schwannomas with intracochlear location.Interventions:Surgical tumor removal through extended round window approach, partial or subtotal cochleoectomy with or without labyrinthectomy and reconstruction of the surgical defect with cartilage, perichondrium or temporal muscle fascia, and bone pâté. Eight patients received a cochlear implant in the same procedure.Main Outcome Measures:Retrospective evaluation of clinical outcome including safety aspects (adverse events) and audiological performance at early follow up in cases of cochlear implantation.Results:The tumor was successfully removed in all cases without macroscopic (operation microscope and endoscope) tumor remnants in the bony labyrinth apart from one case with initial transmodiolar growth. One patient needed revision surgery for labyrinthine fistula. At short-term follow up (3-month post-surgery), good hearing results with the cochlear implant were obtained in all but one patient with a word recognition score of 100% for numbers, and 64 ± 14% for monosyllables (at 65 dB SPL in quiet).Conclusions:Surgical tumor removal and cochlear implantation is a promising treatment strategy in the management of intralabyrinthine schwannoma with intracochlear location, further extending the indication range for cochlear implantation. It is, however, of importance to observe the long-term outcome in these patients and to address challenges like follow up with magnetic resonance imaging.

Objective: To assess the efficacy of cochlear implantation (CI) after surgical removal of sporadic intracochlear or intravestibulocochlear schwannomas. Study Design: Nonconcurrent cohort study. Setting: Monocentric study at a tertiary referral center. Patients: Patients with tumor resection and CI between 2011 and 2018 and a historic control group of CI patients matched by age, CI electrode type, and follow-up. Interventions: Partial or subtotal cochleoectomy for tumor removal and single-stage CI. Outcome Measures: Main outcome measure: word recognition score for monosyllables in quiet at 65 dB SPL. Results: Sixteen patients with tumor removal and CI (6 female, 10 male; mean age 55 ± 14 years) and 16 control patients (6 female, 10 male; mean age 55 ± 15 years) were identified. In the tumor group, surprisingly good word recognition scores were reached even after substantial structural defects in the cochlear capsule. While 12 months after cochlear implantation mean word recognition score for monosyllables in quiet was 58% (SD: 26) and 41% (SD: 26) in the control groups, it was 75% (SD: 19%) in the tumor group. Conclusions: In patients with intracochlear schwannomas, despite substantial structural damage to the cochlear capsule by partial or subtotal cochleoectomy, a tendency toward better performance with respect to word recognition with CI was observed as compared with other CI patients. The surprisingly good functional results despite substantial cochlear trauma may change clinical thinking with respect to cochlear implantation also beyond this special indication.

Inflammatory, traumatic, and neoplastic diseases of the head and neck are best evaluated with cross-sectional imaging (CT, MRI) in accordance with current guidelines. Conventional x-rays should, in general, only be used for dental evaluation, with rare exceptions.

Due to uncontrollable haemorrhage, an emergency hysterectomy had to be performed 8 weeks later.