A parapharyngeal meningioma presenting as a neck mass and multiple cranial nerve palsies

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A 20-year old Malay female presented with swelling at the angle of the mandible on the left side of 7 months duration. It was associated with neck discomfort, dysphagia and few episodes of aspiration. Examination showed a diffuse fixed swelling at the angle of mandible on the left side. It was non-tender and lymph node was not palpable. Multiple left cranial nerve palsies were elicited involving glossopharyngeal, vagus, accessory and hypoglossal nerves. Intraorally the left tonsil was medialized. A CT scan showed a left parapharyngeal tumour encasing the left carotid artery and left internal jugular vein (Figure 1). It measured 2.6 cm × 4.6 cm × 4.5 cm. The cerebral angiogram showed tumour blush which was not suggestive of a glomus tumour. The feeding vessel was from ascending pharyngeal branch of the external carotid artery. A CT guided trucut biopsy revealed a meningothelial meningioma. She underwent subtotal tumour resection (Figure 2). A parapharyngeal meningioma presenting as a neck mass and multiple cranial nerve palsies