Coexistent vestibular schwannoma and meningioma in a patient without neurofibromatosis: A case report and review of literature

Table 1 Patients’ characteristics of reported case in the literature

Ref.	Age (yr)/ sex	Main symptoms and signs	Whether differentiate from preoperative MRI	MRI appearance	Surgical findings	Extend of resection	Operative approach	The histological type of meningioma	Postoperative facial nerve	Follows up (mo)
Present case	63/F	Progressive left side hearing loss, tinnitus and giddiness 1 yr. Facial numbness and intermittent headache for 6 mo	Y	VS: A 1.97 cm × 2.61 cm × 2.80 cm abnormal well-defined signal at the left CPA, with hypo- seen on T1WI and hyper- on T2WI. Slightly hypo- was seen on FLAIR. The lateral border and acoustic nerve were enhanced on contrast enhanced MRI. Meningioma: Slightly hypo- was on T1WI, slightly hyper- on T2WI and FLAIR. The lesion and adjoining dura were significantly enhanced after gadolinium administration	The tumor locating at the CPA was soft, and contained a large cystic component. The tumor located the cavernous sinus was greyish and was attached to the dura	Both GTR	Retrosigmoid craniotomy	Meningothelial meningioma	The anatomical continuity of VII nerve was maintained	Follow-up 6 mo with stable condition, without recurrence or residual tumor. The facial paralysis was gradually improved
Verma et al[4]	40/F	Progressive hearing loss left ear, tinnitus, and giddiness for 18 mo and developed gait ataxia since last 9 mo. Tightness of bilateral lower limbs for 6 mo. Progressively headache with intermittent projectile vomiting, and visual obscuration for 15 d	Y	A well-defined extra-axial 4.5 cm × 4.9 cm × 4.1 cm lesion in left CPA originating from IAC. The lesion was hypo- in T1WI, heterogeneously hyper- on T2WI with heterogeneous contrast enhancement. Another well-defined extra-axial 10 mm × 12 mm × 9 mm lesion posterolateral to first mass which was iso- on T1WI, mildly hyper- on T2WI, and homogenous post-contrast enhancement	A smaller tumor broad-based on dura was encountered initially after retraction of the cerebellum posterolaterally to the larger lesion noted to be arising from the IAC which was occupying the left CPA	Both GTR	Retrosigmoid craniotomy	Meningothelial meningioma	The anatomical continuity of 7th nerve was maintained. Worsening of the VII nerve palsy (House and Brackmann Grade V)	At follow-up of 11 mo, patient was ambulant without support, taking oral feeds with improving VII nerve paresis
Frassanito et al[8]	72/M	5-yr history of hearing loss	Y, the radiological features suggested the co-presence of two different tumors within the same CPA	A tumor in the left CPA with two continuous components differently enhancing after gadolinium administration	Two spatially continuous lesions were found. The rostral component shows a strict relationship with 8th and 7th cranial nerves	N/A	Retrosigmoid craniotomy	Meningothelial meningioma	N/A	N/A
Grauvogel et al[9]	46/F	A history of acute hearing loss and intermittent tinnitus on left side as well as slight gait ataxia for several weeks	N, could not be clearly separated	A homogenous contrast-enhancing tumor in the IAC with extension in the CPA. The tumor portion in the CPA showed broad attachment to the dura of the petrous bone. There were no differences in contrast enhancement of the tumor	It revealed two distinct tumors, a small VS and a meningioma with clear broad attachment to the dura of the petrous bone. The meningioma located a little above and anterior of the VII and VIII cranial nerves	Both GTR	Lateral suboccipital approach	Fibromatous meningioma	Facial nerve function was completely preserved (House and Brackmann grade I)	Follow-up MRI 3 mo after surgery showed complete removal of both tumors and no signs of tumor recurrence
Jain et al[10]	33/M	Redness of the right eye, episodic diplopia, and right-side face numbness for 2 mo	N	Bilateral parasellar masses abutting bilateral body and lower wing of sphenoid and extending to the anterior aspect of the petrous apex. The masses were hypo- on T1WI and hyper- in T2 with contrast enhancement	Intraoperatively, a tumor of variable color and consistency was identified arising from the Vth nerve. The color ranged from creamy white to grayish with areas of fibrosis and old hemorrhage, and a soft to firm consistency	N/A	Right pterional craniotomy and subtemporal intradural approach	Transitional meningioma	By the time of discharge, the patient had up to 50% recovery of the right-side face sensory loss	N/A
Kutz et al[11]	43/F	Severe bifrontal headaches for 18 mo; right-sided hearing loss and imbalance one month before	N, could not be clearly separated	On enhanced MRI, a less intensely enhancing lesion filled the IAC and another more intensely enhancing concurrent lesion located more medially. The enhancing mass extended inferiorly to contact the jugular tubercle and extended laterally toward the jugular fossa	Two distinct tumors were found. The tumor involving the IAC was more typical for VS with soft consistency and little bleeding. The tumor adjacent to the brainstem and petrous temporal bone was fibrous and vascular. The petrous temporal bone around the IAC and inferior toward the jugular foramen was grossly involved with tumor	STR (no other detailed information available)	Translabyrinthine craniotomy	Angiomatous meningioma	Facial nerve function was grade I on the House-Brackmann scale	N/A
Izci et al[2]	57/F	3-mo history of headache, left facial numbness, speech disturbance and deafness in the left ear	Y, MRI revealed two different mass in the left CPA	A heterogeneously contrast-enhancing 3 cm × 3.1 cm × 3.2 cm lesion in the left CPA with obvious edema, compressing pons, mesencephalon, 4th ventricle and cerebella, and showed mild extension into the IAC. Another homogenous contrast-enhancing locating laterally to the first lesion with 12 mm in diameter and attached to the left tentorium cerebelli	Two distinct tumors were totally resected, respectively. (No other detailed information available)	Both GTR	Lateral suboccipital approach	Fibromatous meningioma	The 7th and 8th were observed intact but were serious compressed. Neurological status was not changed after surgery	Follow-up for 9 yr and no recurrence was observed
Chen et al[3]	48/M	A sudden bilateral hearing loss 16 yr ago. His hearing loss resolved on the right side, but his hearing loss in the left ear had persisted, with some progression	Y, a partly enhancing and nonenhancing left CPA tumor	A mixed enhancing and nonenhancing mass within the left CPA that extended along the 7th and 8th cranial nerves	The posterolateral portions of the tumor were cystic and calcified. The tumor appeared to infiltrate the facial nerve and a portion of the brainstem. It was also noted adhering to the facial nerve	STR except for a portion of cystic	Translabyrinthine craniotomy	Fibromatous meningioma	The facial nerve was stimulated at 0.1 mA at the end of the surgery. (no other detailed information available)	N/A
Lüdemann et al[12]	59/F	Progressive loss of hearing for 3 yr	N, a typical VS was assumed preoperatively	A cystic mass in the right CPA of approximately 20 mm × 20 mm × 10mm, which was in close relation to 7th and 8th nerves. On enhanced MRI, the mass was prominent enhanced and was apparently attached to the nerves entering the IAC with irregular margins	The tumor presented with invasion of the surrounding arachnoid membrane and 7th and 8th nerves	N/A	Lateral suboccipital approach	Meningothelialmeningioma	Facial nerve reconstruction was performed using an autologous sural nerve graft. (no other detailed information available)	N/A
Chandra et al[13]	35/M	Progressive right-side hearing loss, tinnitus and giddiness for 3 yr. Developed gait ataxia and increasingly severe headaches in the last 6 mo	N, no other detailed information available	A “dumb-bell” well defined extra-axial tumor in the right CPA with iso- to mild hyper- on T1WI and hyper- on T2WI. The ventral component was cystic-solid component. The lesion was enhancing markedly with gadolinium contrast except the cystic part	Two separate tumors were encountered. The dorsally placed tumor was greyish, vascular and was attached to the petrous bone. Another ventrally placed portion could be completely separated from the dorsal part. This was soft, and contained a large cystic component	Both GTR	Retromastoid suboccipital craniectomy	Angiomatous meningioma	The facial nerve was preserved intraoperative. (The detailed postoperative information could not available)	N/A
Wilms et al[14]	47/F	A sudden onset of the right-side hearing loss. Perioral and perinasal numbness on the right for a few weeks	Y, enhanced MRI showed two distinct components.	Iso on T1WI; two distinct parts was shown on T2WI: The part that was broadly implanted on the petrous bone was iso-; the part around the IAC was inhomogeneously hyper-. On enhanced MRI, two different components of the tumor were clearly shown: An anterior, strongly enhancing part extended into the IAC, and a posterior, less enhancing part was broadly attached to the petrous bone	At surgery, it was confirmed that both a VS and a meningioma arising from the petrous apex were present in this patient	N/A	N/A	Fibromatous meningioma	N/A	N/A

M: Male; F: Female; Y: Yes; N: No; hypo-: Hypointense; hyper-: Hyperintense; Iso-: isointense; MRI: Magnetic resonance imaging; VS: Vestibular schwannoma; CPA: Cerebellopontine angle; T1WI: T1-weighted imaging; T2WI: T2-weighted imaging; FLAIR: Fluid-attenuated inversion recovery; GTR: Gross total resection; STR: Subtotal tumor resection; N/A: Not available.