Meningiomas Of the Internal Auditory Canal

Nakamura, Makoto; Röser, Florian; Mirzai, Shahram; Matthies, Cordula; Vorkapic, Peter; Samii, Madjid

doi:10.1227/01.neu.0000126887.55995.e7

Cited by 45 publications

(27 citation statements)

References 33 publications

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“…1,10,14,16 Multiple factors, including preoperative facial nerve status, surgical approach, anatomical location, and involvement of the IAC, likely contribute to perioperative CN VII dysfunction. 1,10,17,18,23 In the study by Agarwal et al, permanent CN complications were reported in 5.9% patients with tumors smaller than 3 cm and in 45.5% of the cases in which the lesions were larger than 3 cm and were more frequent in those undergoing STR than in those undergoing GTR. 1 Similarly, Leonetti et al reported permanent postoperative complications in 8 (27.6%) patients, with CN VII dysfunction specifically being reported in 3 (10.3%) patients.…”

Section: 25mentioning

confidence: 95%

Efficacy and outcomes of facial nerve–sparing treatment approach to cerebellopontine angle meningiomas

D’Amico¹,

Banu²,

Petridis³

et al. 2017

Journal of Neurosurgery

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ABBREVIATIONS CN = cranial nerve; CPA = cerebellopontine angle; EMG = electromyography; EOR = extent of resection; GKRS = Gamma Knife radiosurgery; GTR = gross-total resection; IAC = internal auditory canal; STR = subtotal resection; TTP = time to progression. SUBMITTED August 3, 2016 OBJECTIVE Advanced microsurgical techniques contribute to reduced morbidity and improved surgical management of meningiomas arising within the cerebellopontine angle (CPA). However, the goal of surgery has evolved to preserve the quality of the patient's life, even if it means leaving residual tumor. Concurrently, Gamma Knife radiosurgery (GKRS) has become an acceptable and effective treatment modality for newly diagnosed, recurrent, or progressive meningiomas of the CPA. The authors review their institutional experience with CPA meningiomas treated with GKRS, surgery, or a combination of surgery and GKRS. They specifically focus on rates of facial nerve preservation and characterize specific anatomical features of tumor location with respect to the internal auditory canal (IAC). METHODS Medical records of 76 patients with radiographic evidence or a postoperative diagnosis of CPA meningioma, treated by a single surgeon between 1992 and 2016, were retrospectively reviewed. Patients with CPA meningiomas smaller than 2.5 cm in greatest dimension were treated with GKRS, while patients with tumors 2.5 cm or larger underwent facial nerve-sparing microsurgical resection where appropriate. Various patient, clinical, and tumor data were gathered. Anatomical features of the tumor origin as seen on preoperative imaging confirmed by intraoperative investigation were evaluated for prognostic significance. Facial nerve preservation rates were evaluated. RESULTS According to our treatment paradigm, 51 (67.1%) patients underwent microsurgical resection and 25 (32.9%) patients underwent GKRS. Gross-total resection (GTR) was achieved in 34 (66.7%) patients, and subtotal resection (STR) in 17 (33.3%) patients. Tumors recurred in 12 (23.5%) patients initially treated surgically, requiring additional surgery and/or GKRS. Facial nerve function was unchanged or improved in 68 (89.5%) patients. Worsening facial nerve function occurred in 8 (10.5%) patients, all of whom had undergone microsurgical resection. Upfront treatment with GKRS for CPA meningiomas smaller than 2.5 cm was associated with preservation of facial nerve function in all patients over a median follow-up of 46 months, regardless of IAC invasion and tumor origin. Anatomical origin was associated with extent of resection but did not correlate with postoperative facial nerve function. Tumor size, extent of resection, and the presence of an arachnoid plane separating the tumor and the contents of the IAC were associated with postoperative facial nerve outcomes. CONCLUSIONS CPA meningiomas remain challenging lesions to treat, given their proximity to critical neurovascular structures. GKRS is a safe and effective option for managing CPA meningiomas smaller than 2.5 cm without associated mass ef...

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Section: 25mentioning

confidence: 95%

Efficacy and outcomes of facial nerve–sparing treatment approach to cerebellopontine angle meningiomas

D’Amico¹,

Banu²,

Petridis³

et al. 2017

Journal of Neurosurgery

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“…VSs tend to show more enhancement than IAC meningiomas with gadolinium. 13) CT more commonly shows dilation of the IAC in cases of VS. Calcification of the tumor and hyperostosis of the petrous bone are radiological signs of meningiomas. In the present case, hyperostosis was observed at the posterior wall of the IAC, which may have been a tumor attachment.…”

Section: Iac Meningioma With Rapidly Progressive Hearing Lossmentioning

confidence: 99%

“…5) The relationship between the facial or cochlear nerve and the tumor is predictable for VSs, but the nerve bundle has a more variable relationship with meningiomas. 13) The only relevant difference between IAC meningiomas and VS is the more common involvement of the facial nerve in IAC. 1) Therefore, wide opening of the IAC is more important for IAC meningiomas to detect the nerve bundle.…”

Section: Iac Meningioma With Rapidly Progressive Hearing Lossmentioning

confidence: 99%

“…3,4) IAC meningiomas are thought to arise from the epithelial lining of the arachnoid villi, which are found at the cranial nerve exit foramina. 13) The most common symptoms of IAC meningiomas are tinnitus and hearing loss, whereas rapidly progressive hearing loss is very unusual. 1,9) We report an unusual case of IAC meningioma with rapidly progressive hearing loss over one month.…”

Section: Introductionmentioning

confidence: 99%

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Meningioma of the Internal Auditory Canal With Rapidly Progressive Hearing Loss -Case Report-

Ishikawa

Kawamata

Kawashima

et al. 2011

Neurol. Med. Chir.(Tokyo)

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A 38-year-old male presented with a meningioma within the internal auditory canal (IAC) manifesting as rapidly progressive hearing loss over a period of one month. He had a 2-year history of tinnitus. Magnetic resonance imaging revealed a 10-mm intracanalicular tumor, which was surgically resected by a retrosigmoid lateral suboccipital approach. The histological findings showed meningothelial meningioma. The patient had no facial palsy after surgery, but his cochlear function did not recover. Common symptoms of IAC meningiomas are tinnitus and hearing loss, but rapidly progressive hearing loss is very rare. IAC meningioma is rare but should be taken into consideration as a cause of rapidly progressive hearing loss.

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“…Clinically, about 20% of dural metastases are symptomatically silent and discovered incidentally on radiological workup. (7) Radiographically, although MR imaging is useful in differentiating malignant soft-tissue tumours from benign ones, dural metastases can be mistaken for benign meningiomas that typically have a ragged border, (9) due to identical dural tail signs on MR imaging. (4) As disease progression is rapid, delayed diagnosis of dural metastasis of NPC also means that it might not be possible to perform appropriate surgical intervention in these patients in a timely manner.…”

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confidence: 99%

Dural metastasis of nasopharyngeal carcinoma: rare, but worth considering

Kuo¹,

Ho²,

Ho³

2014

smedj

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Metastasis of nasopharyngeal carcinoma (NPC) to the dura, an extremely rare condition, can be symptomatically silent and mistaken for a benign entity radiographically. Missed diagnosis can lead to serious consequences or prove immediately fatal. We report a woman with dural metastasis of NPC that mimicked a meningioma on radiography. Craniectomy with tumour resection was performed due to rapid progression from the onset of symptoms to disability. The patient was still alive two years after surgery. This case emphasises the need to keep in mind the possibility of dural metastasis of NPC in patients with abnormal imaging features. This would not only avoid wrong and optimistic diagnosis, but also allow for appropriate treatment in a timely manner. To our knowledge, this is the first report of metastasis of NPC to the dura. We provide detailed information on the neoplastic lesion, which masqueraded as a benign entity and caused potentially fatal consequences. NPC has a propensity to develop distant metastases, with an incidence of 17%-53%, and its most common metastatic sites are the bones, lungs and liver.(3) Intracranial metastases, found in 25% of patients with malignancies, may be categorised by location as skull, dural, leptomeningeal and brain metastases. The diagnostic challenge presented by dural metastasis of NPC is not only associated with the rarity of dural metastasis from NPC but also because dural metastases can be mistaken for a benign entity both clinically and radiographically. Clinically, about 20% of dural metastases are symptomatically silent and discovered incidentally on radiological workup. (7) Radiographically, although MR imaging is useful in differentiating malignant soft-tissue tumours from benign ones, dural metastases can be mistaken for benign meningiomas that typically have a ragged border, (9) due to identical dural tail signs on MR imaging. (4) As disease progression is rapid, delayed diagnosis of dural metastasis of NPC also means that it might not be possible to perform appropriate surgical intervention in these patients in a timely manner.With the dural tail sign on follow-up MR imaging as the only clinical indicator, dural metastasis from NPC was not identified early in our patient, causing an increase in intracranial pressure and subsequent neurological complications. Although the missed diagnosis may have led to fatal consequences, tragedy was narrowly avoided in our patient through prompt treatment (i.e. craniectomy and tumour resection).In conclusion, this report highlights the diagnostic and assessment difficulties clinicians face when dealing with patients diagnosed with NPC following treatment. Clinicians need to maintain a high index of suspicion for dural metastasis in these patients when evidence such as the dural tail sign on repeat MR imaging is present. We recommend that a diagnosis of benign dural lesion be made only if a malignant lesion is excluded. R E FE R E N CE S

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Meningiomas Of the Internal Auditory Canal

Cited by 45 publications

References 33 publications

Efficacy and outcomes of facial nerve–sparing treatment approach to cerebellopontine angle meningiomas

Efficacy and outcomes of facial nerve–sparing treatment approach to cerebellopontine angle meningiomas

Meningioma of the Internal Auditory Canal With Rapidly Progressive Hearing Loss -Case Report-

Dural metastasis of nasopharyngeal carcinoma: rare, but worth considering

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