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Journal of Neurosurgical Sciences 2000 March;44(1):25-32

lingua: Inglese

Acoustic intrameatal meningiomas

Rinaldi A. 1, Gazzeri G. 1, Callovini G. M. 1, Masci P. 2, Natali G. 3

1 Division of Neurosurgery, S. Filippo Neri Hospital, Rome, Italy;
2 Service of Histopathology, S. Filippo Neri Hospital, Rome, Italy;
3 Department of Neuroradiology, S. Filippo Neri Hospital, Rome, Italy


Background. The spo­rad­ic find­ing of an acous­tic intra­mea­tal menin­gio­ma stim­u­lat­ed ­the authors to ­the ­present ­study. An anal­y­sis of ­the cas­es pre­vi­ous­ly report­ed in ­the lit­er­a­ture ­aimed to out­line a pre­lim­i­nary ­account ­about bio­log­i­cal, radio­log­i­cal ­and sur­gi­cal spe­cif­ic hall­marks of ­these ­tumours.
Methods. Eight pre­vi­ous cas­es of menin­gio­mas, meet­ing ­the pre­req­ui­site of ori­gin ­and sit­u­a­tion with­in ­the inter­nal acous­tic ­canal, ­have ­been dis­cov­ered in ­the ­known lit­er­a­ture ­since 1975. A fur­ther ­case ­was recent­ly ­observed in ­our expe­ri­ence. The cas­es in ­the ­series ­showed no ­sex prev­a­lence ­and in ­most of ­them ­the ­age of inci­dence ­was com­prised ­between ­the ­fifth ­and ­sixth ­decade of ­life. Hearing ­loss ­was ­the prev­a­lent symp­tom, last­ing 1 ­month to 7 ­years ­before pres­en­ta­tion. Myelocisternography, mye­lo-CT or ­high res­o­lu­tion CT/MR ­revealed no spe­cif­ic radio­log­i­cal fea­tures to dis­tin­guish ­small intra­mea­tal menin­gio­mas ­from ­the ­more fre­quent­ly occur­ring ves­tib­u­lar schwan­no­mas, ­while CT ­scan ­with ­bone algo­rithm ­could ­point ­out val­u­able indi­rect ­details ­for dif­fe­ren­tial diag­no­sis. Various sur­gi­cal approach­es, i.e. mid­dle fos­sa, trans­lab­y­rin­thine ­and ret­ro­mas­toid, ­were uti­lized by ­the dif­fer­ent authors.
Results. Basing on appar­ent indi­vid­u­al sur­gi­cal pref­er­ence, ­one of ­three dif­fer­ent sur­gi­cal ­routes (trans­lab­y­rin­thine, mid­dle fos­sa, ret­ro­mas­toid) ­was cho­sen ­for 10 pro­ce­dures in 9 ­patients. In ­all, ­except ­two cas­es ­the impres­sion at sur­gery ­was of com­plete ­tumour remov­al.
Conclusions. The pos­sibil­ity ­for menin­gio­mas to ­recur ­and ­invade ­the sur­round­ing ­bone ­requires a dif­fe­ren­tial diag­no­sis ­from ves­tib­u­lar schwan­no­mas. In ­the ­absence of intrin­sic dis­tinc­tive ­signs, radio­log­i­cal eval­u­a­tion of per­i­tu­mo­ral ­bone alter­a­tions ­could ­help diag­no­sis. Although ­the var­i­ous sur­gi­cal ­routes ­have ­often ­proved effec­tive, tem­po­ral ­bone inva­sion jus­ti­fies ­more exten­sive ­approach ­even in ­small ­tumours.

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