A case review designed and co-authored by a Miami Neuroscience Institute surgeon appeared on the cover of the Feb. 2022 issue of the Journal of Neurosurgery.

Michael W. McDermott, M.D., is regarded as the world’s preeminent expert in the surgical management of meningiomas. He conceptualized and designed the study that linked classic Ménière’s disease symptoms to meningiomas located deep inside the skull.

The paper, “Posterior Petrous Face Meningiomas Presenting with Ménière’s-like Syndrome: A Case Series and Review of the Literature,” examined seven cases of posterior petrous face meningiomas involving the vestibular aperture and presenting with symptoms of intermittent vertigo, fluctuating hearing loss, tinnitus and aural fullness.

For the case review, the team examined an institutional database of 2,882 patients with intracranial meningioma undergoing resection. Of those, 144 had petrous face tumors. There were seven cases where patients reported Ménière’s-like symptoms and had posterior petrous face meningiomas overlying the endolymphatic sac.

In each of the seven cases, symptoms improved after the meningiomas were resected.

“Currently, most doctors don’t think these symptoms are related to that little tumor, but we’re showing there can be a relationship,” said Dr. McDermott. “This is an important article for neurosurgeons and neurotologists who have patients presenting with these nondescript, audio vestibular symptoms that no one has been able to treat. Surgical resection works. If you take the tumor out, the symptoms go away.”

Dr. McDermott has defined optimal surgical approaches in the maximal, safe resection of meningiomas. His research influences the classification, diagnosis and grading of meningiomas. Before joining Baptist Health South Florida, where he serves as chief medical executive of Miami Neuroscience Institute, he held the Wolfe Family Endowed Professor in Meningioma Research at the UCSF Medical Center.

While meningiomas are the most common benign tumor of the brain, Dr. McDermott says it’s rare for them to occur on the posterior petrous face. He cautioned that not all patients with tumors in this location will experience these symptoms.

Dr. McDermott pointed out that vestibulocochlear dysfunction generally does not occur with posterior petrous meningiomas unless it involves the vestibular aperture or endolymphatic sac. The tumor may impede endolymphatic fluid reabsorption, causing changes in endolymphatic homeostasis.

“The tumors are positioned such that they are obstructing the reabsorption of endolymph back into circulation. When we take the tumor out, we open the endolymphatic sac and essentially create a shunt. That’s why the patient’s symptoms go away,” Dr. McDermott said.

The surgical approach to these tumors is either a retrosigmoid or presigmoid retrolabyrinthine craniotomy. In these cases, the retrosigmoid craniotomy allows for panoramic exposure of the posterior petrous region, shorter operative time and minimization of CSF leaks associated with presigmoid approaches. Vestibular dysfunction usually improves, regardless of approach.

“Resecting meningiomas in this specific part of the skull base has the potential to significantly improve quality of life for patients struggling with these idiopathic symptoms,” Dr. McDermott said.

Baptist Health Miami Neuroscience Institute offers comprehensive treatment for neurological conditions affecting the brain, spinal cord and peripheral nervous system. Highly specialized experts address a wide range of problems from brain tumors to back pain, movement disorders and seizures to strokes and life-threatening aneurysms. Brain tumor patients have access to the latest treatment technologies and medical therapies as well as expert neurosurgeons, neuro-oncologists and radiation oncologists.