Meningioma of the foramen of Luschka choroid plexus presenting as glossopharyngeal neuralgia: A case report and review of the literature
Sajjad Saghebdoust, Adamantios Ioannis Statyris, Sanjiv Chawda, Jonathan Pollock, Dace Dimante, Ariadni Georgiannakis, Alireza ShoakazemiBackground:
Meningiomas arising from the choroid plexus of the foramen of Luschka (CPFOL) without dural attachment are an exceedingly rare subtype of intracranial tumor. They present a significant diagnostic challenge, as their clinical and radiological features can mimic more common pathologies of the cerebellopontine angle (CPA), such as vestibular or lower cranial nerve schwannomas.
Case Description:
We present the case of a 47-year-old female with a 1-year history of progressive glossopharyngeal neuralgia. Magnetic resonance imaging revealed a homogeneously enhancing lesion in the left CPA. Due to the absence of a dural tail or broad dural base, the lesion was presumptively diagnosed as a lower cranial nerve schwannoma. After documented interval growth, the patient underwent a left retrosigmoid suboccipital craniotomy for tumor resection. Intraoperatively, the tumor was found to originate from the choroid plexus protruding from the foramen of Luschka, with the lower cranial nerves splayed over its capsule. A near-total resection was achieved. Histopathological and molecular analyses confirmed a World Health Organization Grade 1 meningioma with a low-risk integrated molecular profile. The patient experienced a transient, mild postoperative lower cranial nerve palsy that resolved completely. At 12-month follow-up, imaging showed resolution of the small residual tumor, and the patient remained free of her preoperative neuralgic symptoms.
Conclusion:
CPFOL meningioma is a critical entity in the differential diagnosis of CPA masses, particularly those lacking classic dural-based features. A high index of suspicion, coupled with meticulous interpretation of neuroimaging, is essential for accurate preoperative assessment. This case underscores the importance of considering rare tumor origins to avoid diagnostic pitfalls and highlights the utility of multi-modal intraoperative neuromonitoring in achieving maximal safe resection with excellent functional outcomes.