Posterior Petrous Face Meningiomas Presenting with Ménière's-Like Syndrome: A Case Series and Review of The Literature

Objective: Ménière's disease is an inner ear disorder classically characterized by fluctuating hearing loss, tinnitus, and aural fullness accompanied by episodic vertigo. While its pathogenesis remains under debate, histopathological analyses implicate endolymphatic sac dysfunction with inner ear fluid homeostatic dysregulation. Little is known about whether external impingement of the endolymphatic sac by tumors may present with Ménière's-like symptoms. We present a case series of seven patients with posterior fossa meningiomas that involved the endolymphatic sac and new onset of Ménière's-like symptoms and review the literature on this rare clinical entity.

Methods: A retrospective review of patients undergoing resection of a posterior petrous meningioma was performed at the authors' institution. Inclusion criteria were age older than 18 years, patients presenting with Ménière's-like symptoms including episodic vertigo, aural fullness, tinnitus, and/or hearing loss, and tumor location overlying the endolymphatic sac.

Results: There were seven cases of posterior petrous face meningiomas involving the vestibular aperture presenting with Ménière's-like symptoms. Imaging and intraoperative examination confirmed no cranial nerve VIII compression or involvement of the labyrinthine artery to account for audiovestibular symptoms. Of the seven patients in the series, six had significant improvement or resolution of their vertigo, and all seven had improvement or resolution of their tinnitus after resection. For patients that had preoperative hearing loss (n = 5), two had improvement or resolution of their ipsilateral preoperative hearing deficit. The other three patients had unchanged hearing loss compared with preoperative evaluation.

Conclusion: Petrous face meningiomas overlying the endolymphatic sac can present with a Meniere's syndrome. Early recognition and microsurgical excision of these tumors are critical for resolution of most symptoms and stabilization of hearing loss.

Publication History

Article published online:
12 February 2021