[CP angle meningioma presenting as hemifacial spasm].

An interesting case of CP angle meningioma presenting with hemifacial spasm is reported. The patient was a 64-year-old woman with left hemifacial spasm of 18 years' duration which was the initial and the only symptom she had had for ten years until other signs and symptoms including tinnitus and hearing decrease on the left side, vertigo and left cerebellar disturbance occurred. Preoperative CT films showed an enhancing mass at the left CP angle. Operation was performed and the diagnosis of meningioma originating at the rostral edge of the jugular foramen was made. The tumor was extending from the lower cranial nerves up to the Vth nerve burring the VIIth, VIIIth, IXth, Xth, XIIth cranial nerves and vertebral artery within it and compressing the root exit zone of the VIIth nerve. It was totally removed by microsurgical techniques. Postoperative follow-up during eight months disclosed complete disappearance of hemifacial spasm. Residual neurological deficits were left hearing loss, mild facial weakness due to previous nerve blocks on the left side and slight hoarseness. But she was doing well as a housewife. So far, the authors have experienced with 1310 cases of microvascular decompression for hemifacial spasm and 730 cases for tic douloureux. There were only 4 cases (0.3%) in which a CP angle tumor was found in hemifacial spasm series, while in tic douloureux series as many as 79 tumor cases (10.8%) were found. A review of the literature revealed that hemifacial spasm due to CP angle meningioma was very rare, particularly as an initial symptom as in our case.(ABSTRACT TRUNCATED AT 250 WORDS)