Recurrent meningioma mimicking cerebellopontine angle schwannoma: A case report of diagnostic and therapeutic challenges

Meningiomas of the cerebellopontine angle (CPA) are the second most common tumors in this region. However, their clinical and radiological presentations can occasionally mimic those of vestibular schwannomas, leading to significant diagnostic ambiguity. We present the case of a 61-year-old female who developed progressive right-sided hearing loss, intermittent vertigo, and facial twitching six years after the gross total resection of a CPA tumor initially diagnosed as a vestibular schwannoma. Current magnetic resonance imaging (MRI) revealed a recurrent enhancing mass extending into the internal auditory canal, with a subtle dural tail and adjacent hyperostosis.

Multidisciplinary review and subsequent stereotactic biopsy of the recurrent lesion, alongside re-evaluation of the original pathology, confirmed a World Health Organization (WHO) Grade I meningothelial meningioma. Immunohistochemistry (IHC) demonstrated strong positivity for somatostatin receptor 2A (SSTR2A) and epithelial membrane antigen (EMA), while next-generation sequencing identified a TRAF7 mutation in the absence of neurofibromatosis type 2 alterations. The patient was successfully managed with a subtotal resection to preserve facial nerve function, followed by stereotactic radiosurgery for residual disease, achieving stable tumor control at three years. This case underscores the critical importance of comprehensive IHC and molecular profiling in differentiating CPA tumors, highlighting how initial misdiagnosis can alter long-term surveillance and therapeutic strategies.