Meningiomas are the second most common lesion encountered within the cerebe
llo-pontine angle (CPA) and rarely project into or originate from the inter
nal auditory meatus (IAM). It is important to distinguish between meningiom
as land acoustic neuromas preoperatively as the choice of surgical approach
may differ depending on the tumour type. Fortunately, most lesions can be
accurately diagnosed with gadolinium-enhanced magnetic resonace imaging (MR
I). We report six cases of meningioma involving the IAM, often leading to a
n incorrect preoperative MRI diagnosis. We highlight the challenges these t
umors present to radiologists and surgeons.