Cerebellopontine angle meningiomas with primary otologic symptoms.

The majority of cerebellopontine angle (CPA) tumors are acoustic neuromas (AN). However, an intracranial meningioma may occur at this site and will produce symptoms similar to an AN. The most common presenting symptoms of CPA meningiomas are hearing loss, tinnitus, dizziness and dysequilibrium. It cannot be easily distinquished from an AN only on the history and physical examination. Even with an audiogram, evoked response audiometry (ERA) and vestibular function tests, it still cannot be distinquished. CT scan and MRI are helpful in differentiating these two tumors radiographically. In this article, we report two cases of CPA meningiomas which presented with otologic symptoms. The diagnosis and treatment of CPA meningioma is discussed.

Clinicopathological features predicting recurrence of intracranial meningiomas.

A series of 11 recurrent meningiomas was studied. Most lesions occurred in women. The youngest patient was 17 years old and the oldest was 73 years. The mean age was 44 years. Multifactorial risk factors were involved in the tumor regrowth including age of patients, location of tumors, adequacy of initial surgery, certain histopathological features and subtypes of tumors. Tumors in young adults tended to have a rapid interval of regrowth as well as a tendency of multiple recurrences. Brain invasion, extensive bone and muscle involvement, foci of necrosis and hemorrhage, high mitotic index, angioblastic and papillary patterns were common pathological risk factors. Additionally, recurrent tumors may retain their original pathological appearance or become more aggressive by showing marked cellular pleomorphism. Area of liposarcomatous component was encountered in one recurrent lesion.

Symptomatic intraspinal genuine endodermal epithelial cyst.

An intraspinal cervicodorsal endodermal epithelial cyst occurred in a 20-year-old man who experienced sudden paraparesis at the age of 6 years and subsequently developed progressive sensory disturbances. The patient underwent repeated surgical explorations indicating that the lesion may be difficult to identify. The cyst wall consisted of the outer smooth muscle and connective tissue and the inner epithelium that produced mucin and mucopolysaccharide. The intimate association between the epithelium and smooth muscle makes the cyst wall strikingly like the wall of the digestive tract or the respiratory passage and supports the endodermal origin of the cyst which must be distinguished from the neuroepithelial cyst. The pathogenesis of the endodermal epithelial cyst is suggested to be related to congenital maldevelopment of the notochord and the primitive gut.