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Temporal bone secretory meningioma presenting as a middle ear mass.Pathol Res Pract. 2006;202(6):481-4.
A 44-year-old
woman presented with a history of increasing left hypoacusis and
sporadic vertigo. CT scan revealed a tumor occupying the mastoid,
middle ear, and external auditory canal. After surgical removal, a
typical secretory meningioma was diagnosed. The histological hallmark
and the immunohistochemical profile of secretory meningiomas are
reviewed. The differential diagnosis of this tumor in this location is
also commented on. As far as we know, primary temporal bone
meningiomas with secretory histology have not been previously reported
in the medical literature.
Cerebellopontine angle meningioma resulting in middle-ear polyp.J
Laryngol Otol. 2006 Sep;120(9):786-8.
Extracranial
spread of meningiomas to involve the middle ear is very rare. We
present the case of a 43-year-old woman with a known cerebellopontine
angle meningioma who subsequently presented with left-sided otalgia
and a middle-ear mass extruding through the tympanic membrane due to
local invasion of the meningioma. The tumour was excised surgically. A
discussion of the relevant literature is also presented.
Meningioma of the
internal auditory canal: a case report.J
Med Assoc Thai. 2005 Nov;88 (11 ):1707-11.
Meningioma of
the internal auditory canal is very rare. There are only 15 previous
reports of intracanalicular meningioma. The authors add a case report
of a patient with meningioma of the internal auditory canal. A
31-year-old woman presented with a one-year history of headache,
dizziness, hearing loss and left facial paralysis. An MRI of the
temporal bone demonstrated a tiny isointense intracanalicular tumor
with inhomogeneous enhancement. In the operative field carried out by
translabyrinthine approach, the tumor was found in the IAC without
intracranial involvement. Pathology revealed a meningioma. The patient
was followed up for 2 years without recurrence.
Meningiomas of the
cerebellopontine angle with extension into the internal auditory
canal. J
Neurosurg. 2005 Jan;102(1):17-23.
OBJECT: Only
some meningiomas of the cerebellopontine angle (CPA) extend into the
internal auditory canal (IAC) or arise from its dural lining. The
authors investigated cases of CPA tumors in which the meningioma was
inserted in the dura mater in or at the ICA or infiltrated a cranial
nerve. METHODS: The authors reviewed patient charts including surgical
and clinical records, intraoperative recordings of auditory evoked
potentials, records of postoperative auditory examinations, and
imaging studies. In a series of 421 patients harboring CPA meningiomas,
72 patients in whom there was dural involvement of the IAC were
investigated. Total tumor resection was achieved in 86.1%. In 34
patients, opening of the IAC was required for total tumor removal;
this procedure did not influence the patient functional outcome. Among
patients with secondary involvement of the IAC, anatomical
preservation of the facial and cochlear nerves was obtained in 94%,
whereas among patients in whom the lesion arose from the dura in or at
the IAC these values were 80 and 75%, respectively. Functional
preservation of the seventh and eighth cranial nerves in cases of
tumor extension within the IAC was 86 and 77%, respectively, whereas
in cases in which the IAC was involved it was only 60%. In four of
five patients in whom the tumor had its origin in the dura mater
within the IAC, the seventh or eighth cranial nerve had to be
sacrificed to achieve tumor removal because of the lesion's
infiltrative behavior. Facial nerve reconstruction by sural grafting
was performed in the same operative procedure. CONCLUSIONS:
Meningiomas of the CPA involving the IAC require special surgical
management. Dural involvement of the IAC requires opening by using a
diamond drill, a procedure that does not influence cranial nerve
outcome. The increased rate of cranial nerve morbidity is attributed
to the infiltrative behavior of these meningiomas. If affected nerve
segments have to be sacrificed, immediate reconstruction enables
satisfactory long-term results.
Meningiomas of the
internal auditory canal. Neurosurgery.
2004;55(1):119-27.
OBJECTIVE:
Meningiomas arising primarily within the internal auditory canal (IAC)
are notably rare. By far the most common tumors that are encountered
in this region are neuromas. We report a series of eight patients with
meningiomas of the IAC, analyzing the clinical presentations, surgical
management strategies, and clinical outcomes. METHODS: The charts of
the patients, including histories and audiograms, imaging studies,
surgical records, discharge letters, histological records, and
follow-up records, were reviewed. RESULTS: One thousand eight hundred
meningiomas were operated on between 1978 and 2002 at the
Neurosurgical Department of Nordstadt Hospital. Among them, there were
421 cerebellopontine angle meningiomas; 7 of these (1.7% of
cerebellopontine angle meningiomas) were limited to the IAC. One
additional patient underwent surgery at the Neurosurgical Department
of the International Neuroscience Institute, where a total of 21
cerebellopontine angle meningiomas were treated surgically from 2001
to 2003. As a comparison, the incidence of intrameatal vestibular
schwannomas during the same period, 1978 to 2002, was 168 of 2400
(7%). There were five women and three men, and the mean age was 49.3
years (range, 27-59 yr). Most patients had signs and symptoms of
vestibulocochlear nerve disturbance at presentation. One patient had
sought treatment previously for total hearing loss before surgery. No
patient had a facial paresis at presentation. The neuroradiological
workup revealed a homogeneously contrast-enhancing tumor on magnetic
resonance imaging in all patients with hypointense or isointense
signal intensity on T1- and T2-weighted images. Some intrameatal
meningiomas showed broad attachment, and some showed a dural tail at
the porus. In all patients, the tumor was removed through the lateral
suboccipital retrosigmoid approach with drilling of the posterior wall
of the IAC. Total removal was achieved in all cases. Severe
infiltration of the facial and vestibulocochlear nerve was encountered
in two patients. There was no operative mortality. Hearing was
preserved in five of seven patients; one patient was deaf before
surgery. Postoperative facial weakness was encountered temporarily in
one patient. CONCLUSION: Although intrameatal meningiomas are quite
rare, they must be considered in the differential diagnosis of
intrameatal mass lesions. The clinical symptoms are very similar to
those of vestibular schwannomas. A radiological differentiation from
vestibular schwannomas is not always possible. Surgical removal of
intrameatal meningiomas should aim at wide excision, including
involved dura and bone, to prevent recurrences. The variation in the
anatomy of the faciocochlear nerve bundle in relation to the tumor has
to be kept in mind, and preservation of these structures should be the
goal in every case.
Meningioma of the internal auditory canal: case report. Arq
Neuropsiquiatr.2003 Sep;61 (3A) : 659-62.
Meningiomas
limited to the internal auditory canal (IAC) are rare. Acoustic
neuroma is usually the diagnosis made when a tumor is found in this
location because of its higher frequency. We report on a 58 year-old
woman with a meningioma arising from the IAC and the difficulty to
establish the pre-surgical diagnosis, based on clinical and
radiological features. The perioperative suspicion and confirmation
are very important to deal with the dura and bone infiltration in
order to reduce tumor recurrence.
Primary ear and temporal bone meningiomas: a clinicopathologic study
of 36 cases with a review of the literature. Mod
Pathol. 2003;16(3):236-45.
"Primary" ear and
temporal bone meningiomas are tumors that are frequently misdiagnosed
and unrecognized, resulting in inappropriate clinical management. To
date, a large clinicopathologic study of meningiomas in this anatomic
site has not been reported. Thirty-six cases of ear and temporal bone
meningiomas diagnosed between 1970 and 1996 were retrieved from our
files. Histologic features were reviewed, immunohistochemical analysis
was performed (n = 19), and patient follow-up was obtained (n = 35).
The patients included 24 females and 12 males, aged 10-80 years (mean,
49.6 years), with female patients presenting at an older age (mean,
52.0 years) than male patients (mean, 44.8 years). Patients presented
clinically with hearing changes (n = 20), otitis (n = 7), pain (n =
5), and/or dizziness/vertigo (n = 3). Symptoms were present for an
average of 24.6 months. The tumors affected the middle ear (n = 25),
external auditory canal (n = 4), or a combination of temporal bone and
middle ear (n = 7). The tumors ranged in size from 0.5 to 4.5 cm in
greatest dimension (mean, 1.2 cm). Radiographic studies demonstrated a
central nervous system connection in 2 patients. Histologically, the
tumors demonstrated features similar to those of intracranial
meningiomas, including meningothelial (n = 33), psammomatous (n = 2),
and atypical (n = 1). An associated cholesteatoma was identified in 9
cases. Immunohistochemical studies confirmed the diagnosis of
meningioma with positive reactions for epithelial membrane antigen
(79%) and vimentin (100%). The differential diagnosis includes
paraganglioma, schwannoma, carcinoma, melanoma, and middle ear
adenoma. Surgical excision was used in all patients. Ten patients
developed a recurrence from 5 months to 2 years later. Five patients
died with recurrent disease (mean, 3.5 years), and the remaining 30
patients were alive (n = 25, mean: 19.0 years) or had died (n = 5,
mean: 9.5 years) of unrelated causes without evidence of disease. We
conclude that extracranial ear and temporal bone meningiomas are rare
tumors histologically similar to their intracranial counterparts. They
behave as slow-growing neoplasms with a good overall prognosis (raw
5-y survival, 83%). Extent of surgical excision is probably the most
important factor in determining outlook because recurrences develop in
28% of cases.
Meningioma in the internal auditory canal.J
Laryngol Otol. 2001Jan;115(1): 48-9.
A case is
presented of an entirely intracanalicular meningioma in a 48-year-old
woman that was excised via a conventional translabyrinthine approach
to the internal auditory canal (IAC). Pre-operative magnetic resonance
imaging (MRI) suggested that the tumour was a vestibular schwannoma
(VS). Histological examination confirmed the intra-operative
impression that the tumour was a meningioma. Although VS is by far the
commonest intracanalicular tumour, the differential diagnosis includes
meningioma. MRI is unable to distinguish between these two entities
when the tumour is located entirely in the internal auditory canal.
Middle ear meningiomas.
Ann Diagn Pathol. 2000 Jun;4(3):149-53.
Meningiomas
arising in or presenting as middle ear lesions are relatively
uncommon. This study retrospectively reviews the clinicopathologic
features of six meningiomas arising in or extending into the middle
ear. The patients comprise five women and one man ranging in age from
45 to 67 years (median, 55 years) at the time of surgery. Five tumors
arose in the posterior fossa or temporal bone region and one tumor
arose from the auditory canal itself. Three tumors arose on the right
side and three on the left. Duration of symptoms before surgery
involving the middle ear was known in five patients and ranged from 2
to 13 years (median, 10 years). Symptoms at presentation included gait
or balance problems (n = 3), chronic otitis media (n = 2), diplopia (n
= 2), hearing loss (n = 2), pain (n = 1), aural polyp (n = 1), and
tinnitus (n = 1). Histologically, all six tumors resembled a syncytial
(meningotheliomatous) meningioma. Psamomma bodies were noted in two
tumors and two tumors demonstrated mild nuclear pleomorphism. None of
the tumors demonstrated histologic features of atypical meningioma.
Follow-up information was available in five patients. Four patients
had prior surgery for removal of posterior fossa temporal bone
meningiomas and developed recurrences involving the auditory canal 60
to 84 months after surgery. At the time of most recent follow-up
examination, three patients were alive with evidence of tumor (65,
112, and 214 months), one patient was alive with no evidence of tumor
(99 months), one patient died in the postoperative period of sepsis
and pneumonia following resection of a middle ear recurrence (64
months), and one patient was lost to follow-up analysis. Meningiomas
arising in or extending to the middle ear canal are unusual. They more
commonly arise in woman and in most cases involve extension of
intracranial/cranial tumors into the canal.
Temporal meningiomas presenting as chronic otitis media.Am
J Otol. 1993 Jul;14(4):403-6.
Two cases of
temporal bone meningiomas presenting as chronic drainage ears are
presented. One case was indicated by computer tomographic scan at the
time of initial surgery to be limited to the middle ear, but recurred
9 months later with extensive cerebellopontine angle extension and
cranial nerve palsies. The tumor in the second case extended from the
middle ear to the cavernous sinus, with extensive intradural
involvement. Meningiomas involving the middle ear must be considered
to have intracranial extension, and magnetic resonance is the imaging
study of choice.
Meningiomas of the jugular foramen.Otolaryngol
Head Neck Surg. 1992 Feb;106(2):128-36.
Meningiomas of
the jugular foramen manifest the same signs and symptoms as glomus
jugulare tumors. They arise from arachnoid cells lining the jugular
bulb and grow slowly, infiltrating the temporal bone and posterior
fossa. These lesions, however, are more clinically treacherous than
glomus tumors. Meningiomas infiltrate surrounding bone and nerve
tissue and require wide margins of resection to prevent recurrence.
Eight of these lesions have been managed in the past 5 years at the
House Ear Clinic using modern imaging and skull base techniques. Two
have recurred after "total" microsurgical removal. Presentation,
radiologic evaluation, and management guidelines are reviewed.
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