Vestibular schwannoma

Vestibular schwannoma is a histologically benign, generally slow-growing tumour that may remain stable for long periods on follow-up magnetic resonance imaging scans after initial detection.

Progressive unilateral sensorineural hearing loss is the most common presenting symptom, followed by tinnitus and intermittent dizziness; hemifacial numbness or pain may occur less frequently.

Larger tumours may cause headaches, ataxia, and obstructive hydrocephalus and may rarely be life threatening.

Diagnosis is confirmed by gadolinium-enhanced magnetic resonance imaging of the head.

Management includes observation (active surveillance), focused radiation (stereotactic radiosurgery or radiotherapy), or surgery.

Decision-making regarding tumour management is mainly based on the presenting tumour size, detection of growth during active surveillance, provider bias, baseline patient function (e.g., hearing status), and patient preference.

A vestibular schwannoma is a histologically benign, usually slow-growing tumour that develops from the vestibular divisions of the vestibulocochlear nerve, typically presenting with unilateral sensorineural hearing loss.[1]Tos M, Charabi S, Thomsen J. Clinical experience with vestibular schwannomas: epidemiology, symptomatology, diagnosis, and surgical results. Eur Arch Otorhinolaryngol. 1998;255(1):1-6. http://www.ncbi.nlm.nih.gov/pubmed/9592666?tool=bestpractice.com [2]Jones KD. Summary: vestibular schwannoma (acoustic neuroma) consensus development conference. Neurosurgery. 1993 May;32(5):878-9. http://www.ncbi.nlm.nih.gov/pubmed/8492871?tool=bestpractice.com ​​ Vestibular schwannomas are also called acoustic neuromas; however, the term 'acoustic neuroma' is a misnomer because the tumour actually grows from the vestibular component of the vestibulocochlear nerve, rather than from the cochlear or acoustic division, and is pathologically a schwannoma. Although most tumours are now diagnosed at a smaller size in people with less severe symptoms compared to the pre-magnetic resonance imaging era, some tumours are still only detected after growing quite large and may result in brainstem compression and hydrocephalus.[3]Prabhuraj AR, Sadashiva N, Kumar S, et al. Hydrocephalus associated with large vestibular schwannoma: management options and factors predicting requirement of cerebrospinal fluid diversion after primary surgery. J Neurosci Rural Pract. 2017 Aug;8(suppl 1):S27-32. https://ruralneuropractice.com/hydrocephalus-associated-with-large-vestibular-schwannoma-management-options-and-factors-predicting-requirement-of-cerebrospinal-fluid-diversion-after-primary-surgery http://www.ncbi.nlm.nih.gov/pubmed/28936068?tool=bestpractice.com