Diagnostic and treatment problems in skull base meningiomas

Two cases of combined intra- and extracranial meningiomas are presented. It both cases the middle ear problems preceded the diagnosis by several years. The diagnosis was made in one patient because of tumor invasion of the middle ear and in the other because of tumor invesion of the nasal cevity. In both instances the diagnosis was made at a stage at which total tumor removal was considered unwarranted in the light of the paucity of symptoms. A discussion of the clinical behavior of such meningiomas is given. The vast majority of co-called primary extracrenial ectopic meningiomas are not truly primary extracranial tumors, but rather extracranial extensions of intracranial lesions. The importance of computed tomography or magnetic resonance imaging examinations in patients with long-standing middle ear problems of undiagnosed etiology is stressed.