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Florian Roser

Publications and source records attributed to Florian Roser.

At least 19 recordsLinked to original sources
PubMed2006

Medial sphenoid wing meningiomas: clinical outcome and recurrence rate.

OBJECTIVE: To provide clinical data concerning the visual outcome and recurrence rate of medial sphenoid wing meningiomas in consideration of two different subgroups of this tumor entity. METHODS: Among 256 sphenoid wing meningiomas, there were 108 medial sphenoid wing meningiomas of globoid shape. They were classified into Group 1 (without cavernous sinus involvement) and Group 2 (with cavernous sinus involvement). En plaque meningiomas were excluded from the analysis. The charts of the patients including surgical records, discharge letters, follow-up records, and imaging studies were analyzed retrospectively. RESULTS: There were 39 Group 1 tumors and 69 Group 2 tumors. For microsurgical tumor removal, the frontolateral (15.7%) or the pterional approach (84.3%) was performed. Total resection was achieved in 92.3% of patients with Group 1 tumors and 14.5% of those with Group 2 tumors. Radiological recurrence was observed in 7.7% (Group 1 tumors) and 27.5% (Group 2 tumors). The mean follow-up time was 79.04 months (6.59 yr). Improvement of visual function (or stable visual function) was observed in 56% (44%) of patients with Group 1 tumors, in 30% (60%) with newly diagnosed Group 2 tumors, and 10% (70%) undergoing recurrent surgery for Group 2 tumors. CONCLUSION: Group 1 meningiomas present a more favorable subgroup with fortunate visual outcome. In Group 2 tumors, visual improvement was less favorable and radical removal is limited because of cavernous sinus infiltration, with consequential higher recurrence rates. Patients harboring recurrent Group 2 tumors with deteriorating visual function profit from microsurgery because vision can be preserved on the same preoperative level in the majority.

Adult↗
PubMed2006

Tuberculum sellae meningiomas: clinical outcome considering different surgical approaches.

OBJECTIVE: Tuberculum sellae meningiomas present a special challenge because of their proximity to arteries of the anterior circulation, anterior visual pathways, and the hypothalamus. The authors report on the clinical outcome after surgical treatment of tuberculum sellae meningiomas in our neurosurgical department. METHODS: A retrospective study was conducted analyzing the charts of the patients, including surgical records, discharge letters, histological records, follow-up records, and imaging studies. Patients with associated neurofibromatosis Type 2 were excluded from the study. RESULTS: One thousand eight hundred meningiomas were operated on between 1978 and 2002. Seventy-two of these patients had tuberculum sellae meningiomas; four had undergone previous surgical procedures in outside hospitals. Fifty-five patients were women; 17 were men. Their mean age was 54.3 years (range, 30-86 yr). All patients had visual disturbances at presentation. Tumors were operated through the bifrontal approach (n = 21, from 1978 through 1995), the pterional/frontotemporal approach (n = 21, from 1982 through 2002), and the frontolateral approach (n = 30, from 1984 through 2002). Total tumor removal was achieved in most patients (Simpson 1 + 2, 91.7%). The perioperative mortality rate was 2.8% (two out of 72 patients). Immediate postoperative improvement of visual disturbance was observed in 65% of patients. Visual improvement was dependent on the duration of preoperative visual symptoms, but not on preoperative visual acuity or tumor size. The visual improvement rate was significantly better in patients who underwent frontolateral tumor resection (77.8%) compared with those who underwent bifrontal craniotomy (46.2%). The overall recurrence rate was 2.8% (two out of 72 patients). The mean follow-up time for all patients was 4 to 238 months (mean, 45.3 mo [3.8 yr]). CONCLUSION: From 1978 through 2002, tuberculum sellae meningiomas were removed microsurgically using three different surgical approaches. Considering the operative morbidity and mortality, the frontolateral and pterional approach provided remarkable improvement compared with the bifrontal approach. These approaches allowed quick access to the tumor and were minimally invasive with less brain exposure, but still engendered high rates of total tumor removal. By comparison, the frontolateral approach provided the best results concerning visual outcome while representing the least invasive surgical approach.

Adult↗
PubMed2006

Long-standing intraspinal glass fragments causing subsequent radiculopathy after dorsal stabilization.

A 37-year-old female presented with a history of lumbar intraspinal glass fragments due to an accident in childhood. The patient developed progressive right convexity thoracolumbar scoliosis during puberty. Twenty-eight years after the accident, horizontalization of this deformity was performed by dorsal stabilization. Postoperatively the patient complained of acute L-5 radiculopathy. Radiological examination detected multiple glass fragments intra- and extradurally around the L3-4 levels with compression of the dural sac. Microsurgical removal of the extra- and intradural glass fragments led to complete relief of the radicular pain. Foreign bodies can become symptomatic due to changes in the status of the spine, especially during growth in young patients.

Adult↗
PubMed2005

The role of surgery in meningiomas involving the optic nerve sheath.

OBJECTIVE: Clinical presentation, radiological appearance and treatment options of patients with optic nerve sheath meningiomas (ONSM) vary. To provide a baseline for treatment of this tumour entity a series of 24 patients with ONSM is presented. METHOD: Clinical charts of the patients including surgical and histological records, imaging studies as well as meticulously focusing questionnaires of clinical outcome were reviewed. RESULTS: Twenty four patients with ONSM were treated at the Neurosurgical Department from 1981 to 2002. Mean age at diagnosis was 44 years (14-69) with a female:male ratio of 7:1. The preoperative duration of symptoms was negatively correlated with the preoperative visual acuity. The microsurgical approach consisted of pterional craniotomy, intra-/extradural subtotal excision of the meningioma and bony decompression of the optic canal. Surgical results showed low surgical morbidity and preserved or even improved vision in 8/16 patients (50%) all of whom had rapid visual decline preoperatively. In the long-term, visual loss occur again occurred due to recurrence in about 20% of cases. CONCLUSION: Microneurosurgery for treatment of ONSMs is still reserved for cases with intracranial extension, disfiguring proptosis and patients with rapid visual deterioration. Radiotherapy should be considered as treatment option in all other cases as it prolongs the time for functional vision in the affected eye with low morbidity.

Adolescent↗
PubMed2005

Proliferation and progesterone receptor status in benign meningiomas are not age dependent.

BACKGROUND: Some authors have suggested that the biology of meningiomas differs according to a patient's age. Proliferation, vascularity, and hormonal status in meningiomas can be used to describe changes during aging. In the current study, proliferation activity with the Ki-67/MIB-1 antibody was evaluated by immunohistochemistry in meningioma tissue specimens from young and elderly patients. METHODS: Over the past 25 years, tissue samples from 1766 patients with meningiomas were evaluated. Of these, 588 tumor specimens from 554 patients who underwent surgery between 1990 and 2000 were evaluated immunohistochemically. The proliferation index (LI) and progesterone receptor (PR) in meningiomas were quantitatively estimated in elderly (age > or = 70 years) and young patients (age < 70 years). Patients' charts including surgical records, discharge letters, pathology reports, and imaging studies were reviewed. Correlations with histologic subtype, disease recurrence-free survival, resection grade, location, size, vascularity, and tumor calcification were calculated as well. Only patients with a well documented follow-up were included in the statistical evaluation (n = 385). RESULTS: Compared with the young group of 344 patients with meningioma (age < 70 years; mean age, 51.9 years; range, 18-69 years), the elderly population (age > or = 70 years; n = 41; mean age, 74.9 years; range, 70-88 years) showed a male-to-female ratio of 3.2: 1. Both groups had an identical median Ki-67 LI of 3.0% and a PR status of 56.1% versus 58.4 %. No statistically significant differences in disease recurrence-free survival could be found in the two groups. CONCLUSIONS: Proliferation rates and PR status in benign intracranial meningiomas did not appear to be age dependent.

Adolescent↗
PubMed2005

Proliferation potential of spinal meningiomas.

OBJECTIVES: The goal of the present study was to quantitatively assess the proliferation index and progesterone receptor status of spinal versus intracranial meningiomas and to determine if these biological indicators can describe the clinical behavior of these tumors. This information could provide the spinal surgeon with important additional information concerning surgical management and follow-up recommendations for the individual patient. METHODS: The study group consisted of 26 patients with spinal and 241 patients with intracranial meningiomas. Patients with atypical or anaplastic tumors as well as with neurofibromatosis type II were excluded from the study. Furthermore both groups were matched according to age, sex and resection grade (total resection according the Simpson classification). Proliferation index (Ki-67 Labelling index [LI]) and progesterone-receptor (PR) status of spinal and intracranial meningiomas were compared. Clinical charts including surgical and histological records and imaging studies were reviewed. Correlations with histological subtype, intratumoral calcifications, tumor vascularity and recurrence-free survival were analyzed. RESULTS: Compared to the spinal group with a mean Ki-67 LI of 2.48% and a positive PR-status of 46%, proliferation rates of intracranial meningiomas were significant higher (Ki-67 LI 3.6%; P-value 0.041). No significant difference in PR status was seen (spinal PR-status 46%, P-value 0.261). Furthermore spinal meningiomas were less vascularized and showed less intratumoral calcifications. Time to recurrence was similar in spinal and intracranial tumors. CONCLUSION: Spinal and intracranial meningiomas differ in their proliferation activity but not in their PR status. However, despite lower proliferation rates, time to recurrence in spinal and cranial meningiomas is comparable in totally excised tumors. Further studies are needed to determine the role of other biological indicators in spinal meningioma growth and response to therapy.

Adult↗
PubMed2005

Sphenoid wing meningiomas with osseous involvement.

BACKGROUND: Sphenoid wing meningiomas (SWMs) with osseous involvement are neurosurgically challenging because of their position within the skull base and their high rates of recurrence. Sufficient resection of these meningiomas requires extensive surgical exposure. We report on 82 patients with meningiomas infiltrating the sphenoid wing, analyzing radiological appearance and its influence on surgical management. METHODS: Charts of the patients including surgical records, clinical reports, histological examinations, imaging studies, and meticulously focusing questionnaires were reviewed. RESULTS: Among the 82 patients with osseous-involved SWMs, the mean age was 52.2 years in the female group and 54.7 years in the male group with a mean follow-up of 66.23 months (24-206). Histological evaluation revealed World Health Organization grade I meningiomas in 94% of case patients, tumor infiltration of examined bone in all case patients, and proliferation rates of 2.2% Ki-67. Magnetic resonance imaging appearance of the SWMs demonstrated various densities as well as Gd enhancement within the affected bone. Recurrence rates in this subgroup of SWMs are higher (>30%) compared with meningiomas without osseous involvement (11.6%). CONCLUSION: Osseous involvement in SWMs accounts for lower resection and higher recurrence rates than meningiomas in other locations. In those cases with involvement of the cavernous sinus, a subtotal but extensive removal combined with bony decompression of the cranial nerves at the superior orbital fissure and optic canal frequently produces good functional and cosmetic results.

Adult↗
PubMed2005

Facial and cochlear nerve function after surgery of cerebellopontine angle meningiomas.

OBJECTIVE: Meningiomas of the cerebellopontine angle (CPA) share a common location, but their site of dural origin and their relationship to surrounding neurovascular structures of the CPA are variable. The clinical presentation and outcome after surgical resection are different because of the diversity of this tumor entity. We report on a series of 421 patients with CPA meningiomas, with special emphasis on the analysis of the preoperative and postoperative facial and cochlear nerve function in relation to the site of dural attachment and main tumor location in the CPA cistern. METHODS: Among 421 patients, the charts of 347 patients with complete clinical data, including the history and audiograms, imaging studies, surgical records, discharge letters, histological records, and follow-up records, were reviewed retrospectively. Data about preoperative and postoperative facial nerve function were available in 334 patients, and audiometric analysis was conducted in 333 patients. Patients with neurofibromatosis Type 2 were excluded from the study. RESULTS: There were 270 women and 77 men, with a mean age of 53.4 years (range, 17.6-84 yr). Among these patients, 32.9% of the tumors originated at the petrous ridge anterior to the inner auditory canal (IAC) (Group 1), 22.2% showed involvement of the IAC (Group 2), 20.2% were located superior to the IAC (Group 3), 11.8% were inferior to the IAC (Group 4), and 12.9% were posterior to the IAC, originating between the IAC and the sigmoid sinus (Group 5). Patients presented with disturbance of Cranial Nerves V-VIII, the lower cranial nerves, and ataxia, depending on the main tumor location. Tumor resection was performed through a suboccipital-retrosigmoidal approach in the semisitting position in 95% of the patients. A combined supratentorial-infratentorial presigmoidal approach was performed in 5%. Total tumor removal (Simpson Grade 1 and 2) was achieved in 85.9% and subtotal removal in 14.1%. The best initial postoperative facial and auditory nerve function was observed in tumors belonging to Groups 3 and 5. Recovery from preoperative deafness was observed in 1.8% of patients. On long-term follow-up, good facial nerve function (House-Brackmann Grade 1 or 2) was observed in 88.9% of patients. Hearing preservation among patients with preoperative functional hearing was documented in 90.8% on long-term follow-up. CONCLUSION: Although the outcome of facial and cochlear nerve function is different in CPA meningiomas, depending on the topographic classification of these tumors, preservation of the cochlear nerve is possible in every tumor group and should be attempted in every patient with CPA meningioma. It has to be kept in mind that recovery of hearing was also observed in patients with preoperative profound hearing deficits.

Adolescent↗
PubMed2005

Peduncular hallucinosis: insights from a neurosurgical point of view.

OBJECTIVE: Peduncular hallucinosis is a rare phenomenon characterized by visual hallucinosis and agitation. It appears mainly in vascular lesions affecting the brainstem, and some recent reports describe the preoperative and postoperative appearance of peduncular hallucinosis in patients affected through tumor compression at the brainstem. METHODS: Detailing the neurosurgical experiences with this syndrome, we review the available literature and provide pathoneurobiological insights to give the neurosurgeon an overall view of this phenomenon. RESULTS: Peduncular hallucinosis resolves spontaneously, and supportive medications might be helpful. Sacrifice of brainstem draining veins during surgery might contribute to the symptoms. CONCLUSION: The cranial base neurosurgeon should be aware not only of the phenomenon but the surgical influence in provoking it.

Brain Neoplasms↗
PubMed2005

Meningiomas of the cerebellopontine angle with extension into the internal auditory canal.

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.

Adult↗
PubMed2005

Intraoperative auditory brainstem responses in patients with cerebellopontine angle meningiomas involving the inner auditory canal: analysis of the predictive value of the responses.

OBJECT: Meningiomas of the cerebellopontine angle (CPA) can either arise from or secondarily grow into the inner auditory canal (IAC). This location may have a great impact on hearing function following surgery to remove these lesions. The aim of this retrospective study was to investigate the reliability and predictive importance of auditory brainstem responses (ABRs) for the determination of postoperative auditory function in patients with CPA meningiomas in comparison with results obtained in patients who undergo surgery for vestibular schwannomas. METHODS: In a consecutive series of 1800 meningiomas surgically treated between 1978 and 2002, 421 lesions were located in the CPA. In 38 patients with CPA meningiomas involving the IAC, the findings of intraoperative ABR monitoring and the hearing status of each patient before and after surgery were retrospectively analyzed. On analysis, ABR monitoring demonstrated stable findings in 24 patients throughout tumor resection and fluctuating signals in 10 patients. Among the 24 patients with stable ABRs, postoperative hearing function improved in three patients, remained the same in 15, and worsened in six patients, including one patient who displayed postoperative deafness. There was even one patient recovering from preoperative deafness. Among the 10 patients with unstable ABRs, intermittent decreases in amplitude and deformations of variable duration in the ABR wave were noted. The risk of deafness was considerably higher in patients with prolonged phases of intermittent ABR deterioration. CONCLUSIONS: The presence and absence of ABRs during surgery for CPA meningiomas reliably predicted the presence and absence of postoperative auditory function. Intermittent deterioration of ABRs may result in postoperative deafness, depending on the duration of these events during surgery. Improvements in hearing are only seen when the ABRs are stable for amplitudes and latencies throughout surgery.

Adult↗
PubMed2005

Spinal nerve root ganglionitis as a cause of disc herniation: case report.

The authors report on a patient in whom monoradicular pain was caused by ganglionitis of a spinal nerve. Neuroimaging and intraoperative findings identified what were thought to be tumorlike changes in the affected nerve root. The neuropathological examination, however, revealed typical signs of ganglionitis. This rare inflammation usually appears with viral infections, as part of paraneoplastic symptoms, or in the presence of Sjögren disease. Because all of these differential diagnoses were negative in the treated patient, chronic nerve root compression due to disc herniation was suspected as the causative factor for the spinal ganglionitis.

Diagnosis, Differential↗
PubMed2005

Hypericin: a promising fluorescence marker for differentiating between glioblastoma and neurons in vitro.

The naturally occurring photosensitizer, hypericin, with its high quantum yield of singlet oxygen photogeneration was studied for its ability to differentiate between glioblastoma cells and fetal rat neurons using fluorescence microscopy. Eight human glioma cell lines and twelve primary human glioma cell cultures were compared to human astrocytes and cerebellar granule neurons after incubation with 20 microM hypericin for 5-120 min. Photobleaching effects have been studied by exposing the cell lines to 100 msec of excitation light (510-550 wavelength). Mainly, perinuclear hypericin staining was detected. Neurons can be differentiated from glioblastoma cell lines and astrocytes by a lower fluorescence intensity (Tukey-Kramer HSD test, p < 0.0001). Therefore, hypericin seems to be a promising substance for the photodynamic therapy of malignant brain tumors.

Animals↗
PubMed2004

Apoptosis, vascularity, and proliferation in primary central nervous system lymphomas (PCNSL): a histopathological study.

BACKGROUND: In the present study apoptosis, vascularity, and proliferation were quantitatively analyzed with immunohistopathological techniques in primary central nervous system lymphomas (PCNSL). Statistical analysis of these parameters was performed to evaluate their possible relationship with the unfavorable outcome of this tumor. METHODS: A series of 32 PCNSL patients for a total of 33 tumors treated from 1984 to 2000 in the Neurosurgical Department were reviewed, and their histologic specimens examined for apoptosis, vascularity, and proliferation. RESULTS: Patients were treated with either gross total/subtotal tumor removal or stereotactic biopsy. Vascularity was studied by means of FVIII staining, proliferative index with Ki-67 staining, and apoptosis with the TUNEL technique. Most tumors could be classified as immunoblastic or centroblastic B-Cell NHL. Mean Mib-1 Labeling Index was 35.34% (5-80), blood vessel density of 40.8 per 10 high power fields. Apoptotic cells were zero or less than 8 cells per 10 high power fields. CONCLUSION: No statistically significant correlation between survival and histopathological parameters could be shown. However, the apoptosis index was found to be negatively correlated with proliferative index and may account for a more aggressive clinical course of PCNSL.

Adult↗
PubMed2004

Intralesional mitoxantrone biopolymer-mediated chemotherapy prolongs survival in rats with experimental brain tumors.

The present study was designed to test the efficacy of intratumoral biopolymer-mediated mitoxantrone chemotherapy in the rat brain 9L glioma model. Mitoxantrone polymers were tested in vitro in 9L and C6 cell cultures for 10 days. Subsequently, adult Fisher 344 rats were implanted with 5 x 10(4) 9L glioma cells in the frontal region of the brain. In a first experiment, 2 days after cells inoculation, one group of rats were implanted with a biopolymer loaded with 4 mg of mitoxantrone at the tumor site. A second group of rats received drug-free biopolymers and served as controls. In a second experiment, rats were implanted with a biopolymer loaded with 2 mg of mitoxantrone. Another group of rats received 2 mg of mitoxantrone intraperitoneally. Controls received drug-free biopolymers. Rats were sacrificed as soon as they developed progressive neurological deficits. In the first experiment mean survival of mitoxantrone-treated rats was 10+/-2 vs. 15+/-2 days for the control group (P = 0.0003). Early morbidity was seen in 60%, and impaired wound healing was seen in 40% of the 4 mg mitoxantrone treated animals. In the second experiment mean survival of mitoxantrone-treated rats was significantly longer than that of the control group (P < 0.0001) with 33+/-7 vs. 13.8+/-2 days for the control group. Only transient early morbidity (20%) was observed at this dose. All rats in the intraperitoneally mitoxantrone-treated group died within the first 4 days after injection. We conclude that controlled-release EVAc carriers deliver biologically active mitoxantrone in a sustained fashion. In vivo biopolymer-mediated mitoxantrone in loco chemotherapy can significantly prolong survival in rats with intracerebral 9L gliomas. Morbidity is mainly dose related, and can be reduced at acceptable levels without compromising the therapeutic effect.

Animals↗
PubMed2004

Biopolymer-mediated suramin chemotherapy in the treatment of experimental brain tumours.

Suramin inhibits tumour growth and neoangiogenesis by blocking several growth factor receptors. In this study the toxicity and efficacy of intralesional delivery of suramin incorporated in a controlled-release polymer were assessed in a rat 9L tumour model. Initially, the toxicity of the compound was evaluated in adult Fisher 344 rats. The animals were intracerebrally implanted with an ethylene vinyl acetate copolymer. These experiments showed early toxicity in the rats implanted with a 50% load-polymer and 100% mortality within 48 h, whereas in rats implanted with a 33% load-polymer only transient behavioural changes were observed. In a second experiment the rats were stereotactically implanted with 9L cells in the frontal region. Two days after inoculation of cells, the animals were divided into two groups: one group received a 33% suramin load-biopolymer at the tumour implantation site, while the control group received polymer implants only. The interstitial release of suramin in the brain did not produce any improvement in survival of 9L tumour-bearing rats, with a mean survival of 14.2 +/- 1 days for the suramin-treated group versus 13.8 +/- 2 for the control group (p = 0.82). We conclude that intralesional polymer-mediated chemotherapy with suramin does not prolong survival in rats with intracerebral 9L tumours.

Animals↗
PubMed2004

Meningiomas of the internal auditory canal.

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.

Adult↗