Skip to main content
SpringerLink
Log in

Non-schwannomatosis lesions of the internal acoustic meatus—a diagnostic challenge and management: a series report of nine cases

  • Review
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

Vestibular schwannomas (VS) are the most common lesions of cerebellopontine angle (CPA) corresponding to 76–91 % of the cases. Usually, these lesions present typical CT and MRI findings. Non-schwannomatous tumors restricted to the internal auditory meatus (IAM) are rare and their preoperative radiological diagnosis may be difficult. This article describes nine surgically treated intrameatal non-schwannomatous lesions (NSL) and reviews the literature. In the last 16 years, a total of 471 patients with diagnosis of VS were operated on in our department. Preoperatively, 42 patients had diagnosis of intrameatal schwannomas, but surgery revealed in nine cases NSL (3 meningiomas, 3 arachnoiditis/neuritis, 1 cavernoma, 1 vascular loop, and 1 arachnoid cyst). Most frequent symptoms presented by patients with NSL were hearing loss 89 % (8/9) of patients, tinnitus 78 % (7/9), and vertigo 33 % (3/9). Almost all lesions (8/9) presented MRI findings of isointense signal in T1W with contrast enhancement. The only exception was the arachnoid cyst with intracystic bleeding, which was hyperintense in T1W that is not enhanced with contrast. This series shows an occurrence of 21.4 % of non-schwannomatous tumors in 42 cases of lesions restricted to the IAM. Whenever a solely intrameatal enhanced tumor is detected, it is necessary to think about other diagnostic possibilities rather than VS. Therapeutic management may be changed, specially if radiosurgical treatment is considered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Ajal M, Roche J, Turner J, Fagan P (1998) Unusual lesions of the internal auditory canal. J Laryngol Otol 112(7):650–653

    Article  CAS  PubMed  Google Scholar 

  2. Amato MC, Colli BO, Carlotti Junior CG, dos Santos AC, Feres MC, Neder L (2003) Meningioma of the internal auditory canal: case report. Arq Neuropsiquiatr 61(3A):659–662

    Article  PubMed  Google Scholar 

  3. Aquilina K, Nanra JS, Brett F, Walsh RM, Rawluk D (2004) Cavernous angioma of the internal auditory canal. J Laryngol Otol 118(5):368–371

    Article  PubMed  Google Scholar 

  4. Asaoka K, Barrs DM, Sampson JH, McElveen JT Jr, Tucci DL, Fukushima T (2002) Intracanalicular meningioma mimicking vestibular schwannoma. AJNR Am J Neuroradiol 23(9):1493–1496

    PubMed  Google Scholar 

  5. Atlas MD, Fagan PA, Turner J (1992) Calcification of internal auditory canal tumors. Ann Otol Rhinol Laryngol 101(7):620–622

    Article  CAS  PubMed  Google Scholar 

  6. Aubry K, Wassef M, Guichard JP, Herman P, Tran Ba Huy P (2009) Association of an arachnoid cyst with heterotopic neuroglial tissue in the internal auditory canal. Ann Otolaryngol Chir Cervicofac 126(3):133–137

    Article  CAS  PubMed  Google Scholar 

  7. Babu R, Ransohoff J, Cohen N, Zagzag D (1994) Cavernous angiomas of the internal auditory canal. A case report and review of literature. Acta Neurochir (Wien) 129(1–2):100–104

    Article  CAS  Google Scholar 

  8. Bassi P, Zini C, Cusmano F, Sanna M (1985) High resolution O2 computed meatocisternography in the differential diagnosis of internal auditory canal pathology. Neuroradiology 27(1):26–31

    Article  CAS  PubMed  Google Scholar 

  9. Bohrer PS, Chole RA (1996) Unusual lesions of the internal auditory canal. Am J Otol 17(1):143–149

    CAS  PubMed  Google Scholar 

  10. Brackmann DE, Bartels LJ (1980) Rare tumors of the cerebellopontine angle. Otolaryngol Head Neck Surg 88(5):555–559

    CAS  PubMed  Google Scholar 

  11. Breger RK, Papke RA, Pojunas KW, Haughton VM, Williams AL, Daniels DL (1987) Benign extraaxial tumors: contrast enhancement with Gd-DTPA. Radiology 163(2):427–429

    Article  CAS  PubMed  Google Scholar 

  12. Breuer T, Gjuric M, Wigand ME (2000) Extended middle fossa surgery for meningiomas within or at the internal auditory canal. Am J Otol 21(5):729–734

    CAS  PubMed  Google Scholar 

  13. Bricolo A, De Micheli E, Gambin R, Alessandrini F, Iuzzolino P (1995) Cavernous malformation of the internal auditory canal. A case report. J Neurosurg Sci 39(3):153–158

    CAS  PubMed  Google Scholar 

  14. Brookler KH, Hoffman RA, Camins M, Terzakis J (1980) Trilobed meningioma: ampulla of posterior semicircular canal, internal auditory canal, and cerebellopontine angle. Am J Otol 1(3):171–173

    CAS  PubMed  Google Scholar 

  15. Brooks ML, Mayer DP, Sataloff RT, Myers DL, Spiegel JR, Ruiz S (1992) Intracanalicular arachnoid cyst mimicking acoustic neuroma: CT and MRI. Comput Med Imaging Graph 16(4):283–285

    Article  CAS  PubMed  Google Scholar 

  16. Bumm K, Agaimy A, Niedobitek G, Iro H, Steinhart H (2009) A 47-year old male with a cerebellopontine angle tumor. Brain Pathol 19(4):739–742

    Article  PubMed  Google Scholar 

  17. Caylan R, Falcioni M, De Donato G, Ferrara S, Russo A, Taibah A, Sanna M (2000) Intracanalicular meningiomas. Otolaryngol Head Neck Surg 122(1):147–150

    Article  CAS  PubMed  Google Scholar 

  18. Chadha NK, Weiner GM (2008) Vascular loops causing otological symptoms: a systematic review and meta-analysis. Clin Otolaryngol 33(1):5–11

    Article  CAS  PubMed  Google Scholar 

  19. Deshmukh VR, Albuquerque FC, Zabramski JM, Spetzler RF (2003) Surgical management of cavernous malformations involving the cranial nerves. Neurosurgery 53(2):352–357

    Article  PubMed  Google Scholar 

  20. Dinh DH, Clark SB, Whitehead M, Amedee R, Bhattacharjee MB (2000) Intracanalicular meningioma. South Med J 93(6):618–621

    Article  CAS  PubMed  Google Scholar 

  21. Doll A, Abu Eid M, Kehrli P, Esposito P, Gillis C, Bogorin A, Jacques C, Dietemann JL (2000) Aspects of FLAIR sequences, 3D-CISS and diffusion-weight MR imaging of intracranial epidermoid cysts. J Neuroradiol 27(2):101–106

    CAS  PubMed  Google Scholar 

  22. Eby TL, Fisch U, Makek MS (1992) Facial nerve management in temporal bone hemangiomas. Am J Otol 13(3):223–232

    CAS  PubMed  Google Scholar 

  23. Francis HW, Nager GT, Holliday MJ, Long DM (1995) Association of heterotopic neuroglial tissue with an arachnoid cyst in the internal auditory canal. Skull Base Surg 5(1):37–49

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  24. Fujimoto C, Ito K, Ishimoto S, Iwasaki S (2007) Large jugular bulb diverticulum invading the internal auditory canal. Ann Otol Rhinol Laryngol 116(8):631–636

    Article  PubMed  Google Scholar 

  25. Gantz BJ, Lowder MW, McCabe BF (1989) Audiologic results following reimplantation of cochlear implants. Ann Otol Rhinol Laryngol Suppl 142:12–16

    CAS  PubMed  Google Scholar 

  26. Gerganov VM, Hore N, Herold C, Wrede K, Stan AC, Samii A, Samii M (2008) Bilateral malignant melanoma metastases to the internal auditory canal/cerebellopontine angle: surgical management and preservation of function. J Neurosurg 108(4):803–807

    Article  PubMed  Google Scholar 

  27. Gu CS, Liu CY, Wang MC (2009) Brain metastasis of non-small cell lung cancer presenting as sensorineural hearing loss and vertigo. J Chin Med Assoc 72(7):382–384

    Article  PubMed  Google Scholar 

  28. Haught K, Hogg JP, Killeffer JA, Voelker JL, Schochet SS Jr (1998) Entirely intracanalicular meningioma: contrast-enhanced MR findings in a rare entity. AJNR Am J Neuroradiol 19(10):1831–1833

    CAS  PubMed  Google Scholar 

  29. Herzog JA, Bailey S, Meyer J (1997) Vascular loops of the internal auditory canal: a diagnostic dilemma. Am J Otol 18(1):26–31

    CAS  PubMed  Google Scholar 

  30. Hilton MP, Kaplan DM, Ang L, Chen JM (2002) Facial nerve paralysis and meningioma of the internal auditory canal. J Laryngol Otol 116(2):132–134

    Article  CAS  PubMed  Google Scholar 

  31. Hodgson TJ, Kingsley DP (1995) Meningioma presenting as a mass in the internal auditory canal. Neuroradiology 37(6):479–480

    Article  CAS  PubMed  Google Scholar 

  32. Ishikawa N, Komatsuzaki A, Tokano H (1999) Meningioma of the internal auditory canal with extension into the vestibule. J Laryngol Otol 113(12):1101–1103

    Article  CAS  PubMed  Google Scholar 

  33. Kim M, Rowed DW, Cheung G, Ang LC (1997) Cavernous malformation presenting as an extra-axial cerebellopontine angle mass: case report. Neurosurgery 40(1):187–190

    CAS  PubMed  Google Scholar 

  34. Kioumehr F, Dadsetan MR, Feldman N, Mathison G, Moosavi H, Rooholamini SA, Verma RC (1995) Postcontrast MRI of cranial meninges: leptomeningitis versus pachymeningitis. J Comput Assist Tomogr 19(5):713–720

    Article  CAS  PubMed  Google Scholar 

  35. Krainik A, Cyna-Gorse F, Bouccara D, Cazals-Hatem D, Vilgrain V, Denys A, Rey A, Sterkers O, Menu Y (2001) MRI of unusual lesions in the internal auditory canal. Neuroradiology 43(1):52–57

    Article  CAS  PubMed  Google Scholar 

  36. Lalwani AK, Jackler RK (1993) Preoperative differentiation between meningioma of the cerebellopontine angle and acoustic neuroma using MRI. Otolaryngol Head Neck Surg 109(1):88–95

    CAS  PubMed  Google Scholar 

  37. Langman AW, Jackler RK, Althaus SR (1990) Meningioma of the internal auditory canal. Am J Otol 11(3):201–204

    CAS  PubMed  Google Scholar 

  38. Lenarz M, Durisin M, Kamenetzki P, Becker H, Kreipe HH, Lenarz T (2007) Cavernous hemangioma of the internal auditory canal. Eur Arch Otorhinolaryngol 264(5):569–571

    Article  PubMed  Google Scholar 

  39. Lo WW, Horn KL, Carberry JN, Solti-Bohman LG, Wade CT, Brackmann DD, Waluch V (1986) Intratemporal vascular tumors: evaluation with CT. Radiology 159(1):181–185

    Article  CAS  PubMed  Google Scholar 

  40. Loo SW, Dean AF, Murray P (2009) Internal auditory canal metastasis mimicking a vestibular schwannoma at presentation—a case report and review of the literature. Int Semin Surg Oncol 6:8

    Article  PubMed Central  PubMed  Google Scholar 

  41. Lunardi P, Mastronardi L, Nardacci B, Acqui M, Fortuna A (1993) “Dural tail” adjacent to acoustic neuroma on MRI: a case report. Neuroradiology 35(4):270–271

    Article  CAS  PubMed  Google Scholar 

  42. Maniglia AJ (1978) Intra and extracranial meningiomas involving the temporal bone. Laryngoscope 88(9 Pt 2 Suppl 12):1–58

    CAS  PubMed  Google Scholar 

  43. McDermott AL, Dutt SN, Irving RM, Pahor AL, Chavda SV (2003) Anterior inferior cerebellar artery syndrome: fact or fiction. Clin Otolaryngol Allied Sci 28(2):75–80

    Article  PubMed  Google Scholar 

  44. Ment LR, Ehrenkranz RA, Duncan CC (1986) Bacterial meningitis as an etiology of perinatal cerebral infarction. Pediatr Neurol 2(5):276–279

    Article  CAS  PubMed  Google Scholar 

  45. Mirimanoff RO, Dosoretz DE, Linggood RM, Ojemann RG, Martuza RL (1985) Meningioma: analysis of recurrence and progression following neurosurgical resection. J Neurosurg 62(1):18–24

    Article  CAS  PubMed  Google Scholar 

  46. Mori K, Handa H, Gi H (1980) Cavernomas in the middle fossa. Surg Neurol 14(1):21–31

    CAS  PubMed  Google Scholar 

  47. Nager GT, Masica DN (1970) Meningiomas of the cerebello-pontine angle and their relation to the temporal bone. Laryngoscope 80(6):863–895

    Article  CAS  PubMed  Google Scholar 

  48. Nakamura M, Roser F, Mirzai S, Matthies C, Vorkapic P, Samii M (2004) Meningiomas of the internal auditory canal. Neurosurgery 55(1):119–128

    Article  PubMed  Google Scholar 

  49. Namba S (1983) Extracerebral cavernous hemangioma of the middle cranial fossa. Surg Neurol 19(4):379–388

    Article  CAS  PubMed  Google Scholar 

  50. Nedzelski J, Tator C (1982) Other cerebellopontine angle (non-acoustic neuroma) tumors. J Otolaryngol 11(4):248–252

    CAS  PubMed  Google Scholar 

  51. Omojola MF, al Hawashim NS, Zuwayed MA, al Ferayan A (1997) CT and MRI features of cavernous haemangioma of internal auditory canal. Br J Radiol 70(839):1184–1187

    Article  CAS  PubMed  Google Scholar 

  52. Pappas DG, Schneiderman TS, Brackmann DE, Simpson LC, Chandra-Sekar B, Sofferman RA (1989) Cavernous hemangiomas of the internal auditory canal. Otolaryngol Head Neck Surg 101(1):27–32

    CAS  PubMed  Google Scholar 

  53. Parnes SM, Nelson LR (1981) Subarachnoid cyst simulating an intracanalicular acoustic neuroma. Otolaryngol Head Neck Surg 89(6):1019–1020

    CAS  PubMed  Google Scholar 

  54. Pasler D, Baldauf J, Runge U, Schroeder HW (2011) Intrameatal thrombosed anterior inferior cerebellar artery aneurysm mimicking a vestibular schwannoma. J Neurosurg 114(4):1057–1060

    Article  PubMed  Google Scholar 

  55. Plaza G, Lopez Lafuente J, Barriga FJ, Toledano A, De Los Santos G (2000) What clinical significance do vascular anomalies of the outer ear canal have? Acta Otorrinolaringol Esp 51(5):397–402

    CAS  PubMed  Google Scholar 

  56. Relic A, Schick B, Kronsbein H, Kahle G, Draf W (1999) Bone neogenesis in a rare space-occupying lesion of the inner ear canal. HNO 47(6):563–568

    Article  CAS  PubMed  Google Scholar 

  57. Roser F, Nakamura M, Dormiani M, Matthies C, Vorkapic P, Samii M (2005) Meningiomas of the cerebellopontine angle with extension into the internal auditory canal. J Neurosurg 102(1):17–23

    Article  PubMed  Google Scholar 

  58. Saleh E, Naguib M, Russo A, Taibah AK, Sanna M (1993) Vascular malformation of the internal auditory canal. J Laryngol Otol 107(11):1039–1042

    Article  CAS  PubMed  Google Scholar 

  59. Samii M, Nakamura M, Mirzai S, Vorkapic P, Cervio A (2006) Cavernous angiomas within the internal auditory canal. J Neurosurg 105(4):581–587

    Article  PubMed  Google Scholar 

  60. Schrock A, Laffers W, Bootz F (2006) Solitary metastasis of lung carcinoma to the internal auditory canal. Am J Otolaryngol 27(3):214–216

    Article  PubMed  Google Scholar 

  61. Schuknecht HF, Gao YZ (1983) Arachnoid cyst in the internal auditory canal. Ann Otol Rhinol Laryngol 92(6 Pt 1):535–541

    Article  CAS  PubMed  Google Scholar 

  62. Shelton C, Brackmann DE, Lo WW, Carberry JN (1991) Intratemporal facial nerve hemangiomas. Otolaryngol Head Neck Surg 104(1):116–121

    CAS  PubMed  Google Scholar 

  63. Silveira RL, Andrade GC, Pinheiro Junior N, Pittella JE, Barbosa VC (2005) Cavernous hemangioma of the internal auditory canal encasing the VII and VIII cranial nerve complex: case report. Arq Neuropsiquiatr 63(1):163–165

    Article  PubMed  Google Scholar 

  64. Singh KP, Smyth GD, Allen IV (1975) Intracanalicular meningioma. J Laryngol Otol 89(5):549–552

    Article  CAS  PubMed  Google Scholar 

  65. Starkman SP, Brown TC, Linell EA (1958) Cerebral arachnoid cysts. J Neuropathol Exp Neurol 17(3):484–500

    Article  CAS  PubMed  Google Scholar 

  66. Sun Y, Wrede KH, Chen Z, Bao Y, Ling F (2009) Ruptured intrameatal AICA aneurysms—a report of two cases and review of the literature. Acta Neurochir (Wien) 151(11):1525–1530

    Article  Google Scholar 

  67. Sundaresan N, Eller T, Ciric I (1976) Hemangiomas of the internal auditory canal. Surg Neurol 6(2):119–121

    CAS  PubMed  Google Scholar 

  68. Tator CH (1985) Acoustic neuromas: management of 204 cases. Can J Neurol Sci 12(4):353–357

    CAS  PubMed  Google Scholar 

  69. Thijssen HO, Marres EH, Slooff JL (1976) Arachnoid cyst simulating intrameatal acoustic neuroma. Neuroradiology 11(4):205–207

    Article  CAS  PubMed  Google Scholar 

  70. Wong JH, Awad IA, Kim JH (2000) Ultrastructural pathological features of cerebrovascular malformations: a preliminary report. Neurosurgery 46(6):1454–1459

    Article  CAS  PubMed  Google Scholar 

  71. Yamakawa H, Hattori T, Tanigawara T, Sahashi Y, Ohkuma A (2004) Intracanalicular aneurysm at the meatal loop of the distal anterior inferior cerebellar artery: a case report and review of the literature. Surg Neurol 61(1):82–88

    Article  PubMed  Google Scholar 

  72. Zabramski JM, Wascher TM, Spetzler RF, Johnson B, Golfinos J, Drayer BP, Brown B, Rigamonti D, Brown G (1994) The natural history of familial cavernous malformations: results of an ongoing study. J Neurosurg 80(3):422–432

    Article  CAS  PubMed  Google Scholar 

  73. Zeitouni AG, Zagzag D, Cohen NL (1997) Meningioma of the internal auditory canal. Ann Otol Rhinol Laryngol 106(8):657–661

    Article  CAS  PubMed  Google Scholar 

  74. Zotta DC, Stati G, De Paulis D, Galzio RJ (2011) Intrameatal aneurysm of the anterior inferior cerebellar artery. J Clin Neurosci 18(4):561–563

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no competing interests.

Author information

Authors and Affiliations

  1. Neurosurgery Department, Instituto de Neurologia de Curitiba—INC, Curitiba, Paraná, Brazil

    Luis Fernando Moura da Silva Jr., Viviane Aline Buffon, Maurício Coelho Neto & Ricardo Ramina

Authors
  1. Luis Fernando Moura da Silva Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Viviane Aline Buffon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maurício Coelho Neto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ricardo Ramina
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maurício Coelho Neto.

Additional information

Comments

Michaël Bruneau, Brussels, Belgium

The authors report nine cases of non-schwannomatous lesions of the internal auditory meatus out of 42 cases they have operated on in this location with a suspected preoperative diagnosis of vestibular schwannoma. This study is relevant since the literature on this topic is relatively limited, as well as the overall number of reported cases. The final diagnoses were meningiomas, arachnoiditis/neuritis, cavernoma, vascular loop, and arachnoid cyst. With hemangiomas, these lesions represent the most common non-schwannomatous intrameatal lesions. Their clinical and radiological presentations are relatively similar to vestibular schwannomas which are by far more often encountered in this location but their surgical management is completely different. In any doubt, dedicated MRI sequences could be helpful. When facing a non-schwannomatous lesion, the surgeon must be aware that the facial and vestibulocochlear nerves can be displaced in any direction. The surgical strategy will also depend on the final diagnosis and on adherences to the cranial nerves. Meningiomas have to be resected as completely as possible to decrease the recurrence rate, neurovascular conflicts necessitate to perform a microvascular decompression with teflon interposition, arachnoid cysts must be resected or fenestrated; and arachnoiditis and neuritis require a wide nerve decompression.. With a 21.4 % rate of reconsidered diagnosis, this study stresses the importance of being very careful before deciding to propose a radiosurgical treatment, especially in unusual presentations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Moura da Silva, L.F., Buffon, V.A., Coelho Neto, M. et al. Non-schwannomatosis lesions of the internal acoustic meatus—a diagnostic challenge and management: a series report of nine cases. Neurosurg Rev 38, 641–648 (2015). https://doi.org/10.1007/s10143-015-0638-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-015-0638-y

Keywords

Search

Navigation