Restoration of Hearing after Removal of Cerebellopontine Angle Meningioma: Diagnostic and Therapeutic Implications

Abstract

A case of cerebellopontine angle meningioma with restoration of hearing from a profoundly deaf state is presented. Meningiomas of the posterior fossa commonly present with decreased or absent hearing and can appear deceptively similar to acoustic neurinomas on radiographic and audiometric testing. Because total restoration of hearing can occur with meningioma, even with significant preoperative deficit, utilization of the translabyrinthine approach is less desirable if any preoperative question as to the diagnosis exists. Any hearing-impaired patient with a cerebellopontine angle mass that is not conclusively thought to represent acoustic neurinoma should be approached by the suboccipital technique to maximize the opportunity for restoration of hearing.

Facial and Cochlear Nerve Function after Surgery of Cerebellopontine Angle Meningiomas

“…In one deaf patient with a retromeatal tumor (Group 5), even dramatic hearing recovery to normal hearing was observed. Few case reports have previously demonstrated that hearing restoration can occur with CPA meningiomas, even in the face of profound preoperative deficit (4,7,18,35). In our view, these cases show that it is worth attempting hearing preservation in as many patients as possible, even in the case of bad or no clinical preoperative hearing.…”

Hearing Restoration From Deafness After Resection of a Large Cerebellopontine Angle Meningioma. Case Report.

“…1,2,4,6,8,9) This dramatic recovery seems to occur more commonly in`non-acoustic' tumors than in acoustic neuromas. 8) When a tumor is located in a cistern other than the cerebellopontine cistern, the 8th cranial nerve together with its feeder from the internal auditory artery are separated from the tumor by the arachnoid membrane between the two cisterns.…”

“…Consequently, hearing restoration may paradoxically occur in patients with relatively large tumors. 6,8,9) Small tumors with hearing loss, which are usually acoustic tumors, are more likely to impair 8th cranial nerve function directly and radically. Preoperatively, the auditory brainstem response 9) or otoacoustic emissions, 1) which is assumed to be generated by the outer hair cells of the cochlea, may be useful for detecting patients in whom hearing loss is potentially reversible.…”

“…1,2,4,6,8,9) However, tumors associated with profound hearing loss which is still potentially reversible may have been treated with less care, either in selecting an approach or in manipulating the nerve. Awareness of this paradoxical phenomenon associated with non-acoustic tumor, and more care in treatment may increase the number of such cases.…”

“…Furthermore, we should be aware that hearing restoration can occur even after a long history of deafness. Approaches which devastate the cochlear organ such as the transcochlear route should be avoided, 6,8,9) and more careful manipulation in tumor removal is needed to maximize the possibility of hearing restoration after treatment of a non-acoustic tumor.…”