Posterior Fossa Meningioma

Mira Cymerman's left ear was sending her a message. After seeing doctors for persistent ear pain, an Ear, Nose and Throat (ENT) physician sent her for an MRI that revealed something surprising—a tumor on the right side of her brain stem called a posterior fossa meningioma. Learn more about Mira's treatment and recovery.

Phylis Esposito may be retired but she’s certainly not a homebody. After a two-day dizzy spell, she was referred for a CT scan and the results would send her on a path to Dr. Bederson at Mount Sinai. It revealed a golf-ball-sized mass on the right side of her brain that was shifting the tissue of her brain toward the left side, the posterior fossa. Learn more about Phylis' treatment and recovery.

The Mount Sinai Health System is a major referral destination for diagnosis and treatment of posterior fossa and other types of meningiomas. Posterior fossa meningiomas are tumors that form near the bottom of the skull, by the brainstem and cerebellum. This small area controls movement, coordination, and vital body functions such as breathing.

While we do not know what causes posterior fossa meningiomas, these tumors are often benign and slow-growing, arising from the meninges, or layers of tissue that cover the brain and spinal cord. Posterior fossa meningiomas can press on the brain, spinal cord, and the nerves surrounding them.

You may not have any symptoms because meningiomas can grow slowly and do not interfere with brain function right away. Most of the time, we find these tumors incidentally when we perform a magnetic resonance imaging (MRI) scan for another reason. Radiological images with or without contrast can confirm the existence of a posterior fossa meningioma.

If you do experience symptoms, they vary depending on the location. For example, compression near the cranial nerves can cause double vision, hearing loss, facial pain such as trigeminal neuralgia, numbness in the face, and headaches. Posterior fossa meningiomas that compress the brainstem might cause symptoms such as difficulty walking, loss of balance, vertigo, and nausea.

Treatment Options

If you are not experiencing any symptoms, we may prefer to use a conservative approach of watching and monitoring with MRI scans. If you are having difficulties, we might recommend stereotactic radiosurgery, a minimally invasive procedure that uses precise, image-guided beams of radiation. We might also recommend this procedure if your tumor is located in the deep region of the skull, which would make surgical removal difficult.

If we do need surgical intervention, you may undergo a craniotomy, which includes removing part of the skull, then removing the tumor, then putting the skull bone back in place. Sometimes we can perform a transnasal resection (removal of the tumor through the nose). The tumor’s size and location affects this decision.

Recovery depends on the complexity of the procedure. If you had a small superficial posterior fossa meningioma, you might be able to leave the hospital after one to three nights. If the tumor was larger and the procedure was more complex, you might have a longer hospital stay and recovery.

If cleared by your neurosurgeon, we encourage you to get up and walk as soon as possible after the procedure, though you should avoid heavy lifting. Following discharge from the hospital, you will probably require some amount of rehabilitation services, either in the hospital or at home. Occasionally, people require no additional rehabilitation services after discharge. We usually schedule a follow-up appointment for a week or two after you leave the hospital.

The recurrence rate of posterior fossa meningiomas is less than 10 percent after tumor resection (removal). Our team will continue to evaluate and monitor you after the procedure to ensure that you are getting the care you need.