Meningiomas of the Internal Auditory Canal

Laryngoscope. 2021 Feb;131(2):E413-E419. doi: 10.1002/lary.28987. Epub 2020 Aug 18.


Objective: Identify and define specific preoperative and postoperative characteristics of intracanalicular meningiomas (ICMs) in order to improve their diagnosis and management, and to differentiate them from intrameatal vestibular schwannomas (IMVSs).

Methods: Preoperative symptomatology, magnetic resonance imaging (MRI), and postoperative outcomes of 28 ICMs were analyzed. The results were compared to the literature and IMVSs treated by our group.

Results: Anacusis and progressive hearing loss were more frequent in the present population than the cases reviewed (P = .0064 and P = .0001, respectively). Hearing loss affected more than 90% of the patients, with anacusis in 32.1% of the cases. Facial palsy affected 17.9% of the patients. In comparison to IMVSs, preoperative anacusis was more associated to meningiomas (P = .0037), and the facial nerve was more compromised in ICMs than IMVSs, both preoperatively (P = .0011) and at follow-up (P < .0001). According to a re-evaluation of preoperative MRIs and comparison with IMVSs, linear tumor borders, and linear morphology along the internal auditory canal wall, but not the presence of a dural tail, were significantly more present in ICMs (P = .0035, P = .0004, P = .1963, respectively). These characteristics could have led to a correct preoperative diagnosis in 61% of our cases.

Conclusion: Contrariwise to IMVSs, the frequent preoperative anacusis and facial palsy demonstrate the more aggressive nature of ICMs, which also carry a higher risk of postoperative facial palsy and difficulty to preserve hearing. An attentive evaluation of imaging should ease diagnosis, and asymptomatic or stable ICMs should be enrolled in a wait-and-scan protocol.

Level of evidence: 4 Laryngoscope, 131:E413-E419, 2021.

Keywords: Intracanalicular meningioma, internal auditory canal, facial palsy, anacusis.

MeSH terms

  • Diagnosis, Differential
  • Ear Neoplasms / diagnosis
  • Ear Neoplasms / diagnostic imaging
  • Ear Neoplasms / pathology*
  • Ear Neoplasms / surgery
  • Ear, Inner / diagnostic imaging
  • Ear, Inner / pathology*
  • Ear, Inner / surgery
  • Female
  • Humans
  • Labyrinth Diseases / diagnosis
  • Labyrinth Diseases / diagnostic imaging
  • Labyrinth Diseases / pathology*
  • Labyrinth Diseases / surgery
  • Magnetic Resonance Imaging
  • Male
  • Meningioma / diagnosis
  • Meningioma / diagnostic imaging
  • Meningioma / pathology*
  • Meningioma / surgery
  • Middle Aged
  • Neuroma, Acoustic / diagnosis
  • Neuroma, Acoustic / pathology
  • Retrospective Studies