Ménière’s disease is a disease of the inner ear that is diagnosed clinically by symptoms of fluctuating hearing loss, tinnitus, fullness in hearing (sensation causing muffled hearing), and vertigo. Meniere’s disease is often difficult to diagnose due to the range of symptoms commonly involved.
A new study published in the Journal of Neurosurgery makes a critical connection between this disorder and some cases of meningiomas, the most commonly diagnosed primary brain tumors in adults, the majority of which are noncancerous or benign.
Michael McDermott, MD, neurosurgeon and chief medical executive of the Miami Neuroscience Institute, part of Baptist Health, co-authored the study. Posterior facial meningiomas presenting with Ménière-like syndrome: a case series and review of the literature. Dr. McDermott is a world-renowned leader in the neurosciences, with clinical expertise in meningioma surgery.
Considered a world-leading expert in the surgical treatment of meningiomas, Dr. McDermott conceptualized and designed the study linking the classic symptoms of Ménière’s disease to meningiomas located deep within the skull.
For their review, the researchers examined a database of 2,882 patients with intracranial meningioma who underwent resection or surgical removal of the tumor as well as the tumor-infiltrated structures. Of these patients, 144 had facial petrous tumors, which are difficult tumors to treat because of their proximity to cranial nerves, the brainstem, and critical vasculature. There were seven cases in which patients reported symptoms similar to Ménière’s disease and had meningiomas of the posterior petrous face covering the endolymphatic sac, the nonsensory organ of the inner ear.
In each of the seven cases, symptoms improved after resection of the meningiomas.
“At the moment, most doctors don’t think these symptoms are related to this small tumor, but we show there may be a connection,” Dr. McDermott said. “This is an important paper for neurosurgeons and neurologists who have patients with these nondescript audio vestibular symptoms that no one has been able to treat. Surgical resection works. If you remove the tumor, the symptoms disappear.
Dr. McDermott pioneered optimal surgical approaches for the safe and successful resection of meningiomas. His research has influenced the classification, diagnosis, and grading of meningiomas. Prior to joining Baptist Health South Florida, where he served as Chief Medical Officer of the Miami Neuroscience Institute, he was the Wolff Family Meningioma Research Professor at UCSF San Francisco Medical Center.
Although meningiomas are the most common benign brain tumor, Dr. McDermott says it’s rare for them to appear on the back of a petrous face. He cautioned that not all patients with tumors in this location will experience these symptoms.
Dr. McDermott pointed out that vestibulocochlear dysfunction—such as dizziness, vertigo, and balance problems—is not usually seen in posterior petrous meningiomas unless it involves the vestibular foramen or endolymphatic sac, components of the inner ear system that controls balance. The tumor may impede the reabsorption of the endolymphatic fluid, causing changes in the balance.
“The tumors are positioned in such a way that they prevent the reabsorption of endolymph back into the circulation. When we remove the tumor, we open the endolymphatic sac and essentially create a shunt. That’s why the patient’s symptoms go away,” Dr. McDermott said.
Vestibular dysfunction usually improves regardless of the specific surgical approach to remove meningiomas.
“Resection of meningiomas in this specific part of the skull base has the potential to significantly improve the quality of life of patients struggling with these idiopathic symptoms,” said Dr. McDermott.