Objective We report an unusual case of an extraventricular choroid plexus papilloma (CPP) occupying the right ventral foramen magnum and lower right cerebellopontine angle (CPA), occurring together with a petro-tentorial meningioma. The clinical presentation, preoperative imaging, differential diagnosis, surgical treatment and histologic features of the two tumors are discussed. Case description The patient presented with a 2-month history of headache, altered facial sensation, dysphagia, and gait unsteadiness. Neurologic examination confirmed a wide-based, unsteady gait, hoarse voice, anisocoria, and partial right vocal cord paralysis. Diagnostic imaging demonstrated right petro-tentorial and right ventral foramen magnum lesions, both hyperintense on contrasted images and suggestive of meningiomas. A right suboccipital craniotomy and far lateral approach was used to resect both tumors. The petro-tentorial tumor was a histologically confirmed meningioma, but the ventral foramen magnum tumor was an extraventricular CPP. Conclusion This is a rare occurrence of concomitant meningioma and CPP. There is no known link between these two tumors. An exophytic 4th ventricular CPP must be considered in the differential diagnosis of a CPA or foramen magnum tumor.
