Meningiomas are the second most common lesion encountered within the ccrehellopontine angle (CPA). Whereas acoustic neuromas often involve or originate from the internal auditory meatus (IAM) very few meningiomasdo. It is important to distinguish between meningiomas and acoustic neuromas preoperativeby as the need for further investigations and the position and preservation prognosis of the VII and VIII cranial nerves varies between the 2 tumour types. In addition, meningioma resection also involves hone removal at the site of origin to prevent recurrence. We report 6 cases where CPA meningioma has involved the I AM including 2 where the lesion definitely originated from the meatus. We highlight the usual radiological differences between acoustic neuromas and mcningiomas and emphasise that if meningiomas involve or originate from the IAM, preoperative magnetic resonance imaging (MRI) often fails to confirm the diagnosis. We discuss recent advances in MRI technology that may prevent this in future. Meningiomas involving the IAM are often ideal cases to consider for hearing-preservation surgery as hearing often remains unchanged or may even return to normal following resection. We discuss the operative approaches and the dilemmas facing the surgeon operating on these rare meningiomas.