November 23, 2022 by Peter B. Laird
Baptist Health Neurosurgeon’s Key Role in Study Linking Meningiomas to Inner-Ear Disorder With Range of Symptoms
Meniere’s disease is an inner-ear disorder that is clinically diagnosed by symptoms of fluctuating hearing loss, tinnitus, aural fullness (sensation causing muffled hearing), and vertigo. Meniere’s disease is often difficult to diagnose because of the range of symptoms usually involved.
A new study, published in the Journal of Neurosurgery, makes a critical connection between this disorder and certain cases of meningiomas, the most commonly diagnosed primary brain tumors in adults, the vast majority of which are non-cancerous, or benign.
Michael McDermott, M.D.., a neurosurgeon and the chief medical executive of Miami Neuroscience Institute, part of Baptist Health, is co-author of the study, Posterior Petrous Face Meningiomas Presenting with Ménière’s-like Syndrome: A Case Series and Review of the Literature. Dr. McDermott is a world-renowned leader in neurosciences, with a clinical expertise in the field of meningioma surgery.
Regarded as the world’s preeminent expert in the surgical management of meningiomas, Dr. McDermott conceptualized and designed the study, linking classic Meniere’s disease symptoms to meningiomas located deep inside the skull.
For their review, the researchers examined a database of 2,882 patients with intracranial meningioma who were undergoing resection, or the surgical removal of the tumor as well as tumor-infiltrated structures. Of those patients, 144 had petrous face tumors, which are challenging tumors to treat because of their proximity to the cranial nerves, brainstem and critical vasculature. There were seven cases where patients reported Meniere’s-like symptoms and had posterior petrous face meningiomas overlying the endolymphatic sac, the non-sensory organ of the inner ear.
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 pioneered optimal surgical approaches to safely and successfully resect meningiomas. His research has influenced 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 in San Francisco.
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 – such as dizziness, vertigo and balances issues — generally does not occur with posterior petrous meningiomas, unless it involves the vestibular aperture or endolymphatic sac—components of the inner ear system that controls balance. The tumor may impede endolymphatic fluid reabsorption, causing changes in equilibrium.
“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.
Vestibular dysfunction usually improves, regardless of the specific surgical approach to removing the meningiomas.
“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.