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Updated: Dec 26 2021

Vestibular Schwannoma (Acoustic Neuroma)

  • Snapshot
    • A 44-year-old man presents to his primary care physician for worsening hearing loss. His hearing loss is most severe in his right ear. He has noticed decreased facial sensation on the right side of the face. Physical examination is notable for a sensorineural hearing loss affecting the right ear and decreased sensation to pin-prick in the right face. An MRI brain demonstrates an enlarged mass in the internal acoustic meatus, extending to the cerebellopontine angle.
  • Introduction
    • Overview
      • a Schwann cell-derived tumor arising from the 8th cranial nerve
        • typically the vestibular portion
        • usually unilateral (~90% of cases)
  • Epidemiology
    • Demographics
      • median age is ~50 years
  • etiology
    • Associated conditions
      • neurofibromatosis type 2
        • characteristically presents as bilateral acoustina neuromas
          • secondary to a mutation in merlin in chromosome 22
  • Presentation
    • Symptoms/physical exam
      • cochlear nerve involvement
        • sensorineural hearing loss
        • tinnitus
      • vestibular nerve involvement
        • unsteady gait
      • can have other cranial nerve involvement
        • facial and trigeminal nerve involvement
          • facial nerve
            • facial paresis
            • taste disturbaces
          • trigeminal nerve
            • facial paresthesia and pain
  • Imaging
    • MRI brain with gadolinium
      • indication
        • imaging study of choice
      • fundings
        • enhancing lesion in the internal auditory canal that may extend into the cerebellopontine angle
  • Studies
    • Audiometry
      • indication
        • best initial screening laboratory test
  • Differential
    • Neurofibromatosis type 2
      • differentiating factors
        • associated with bilateral acoustic neuromas, cataracts, meningiomas, and ependymomas
    • Meningioma
      • differenting factors
        • tumor involving the meninges only
  • Treatment
    • Medical
      • radiation therapy
        • indication
          • small tumors or patients who are not surgical candidates
        • options
          • sterotactic radiosurgery
          • sterotactic radiotherapy
    • Surgical
      • microsurgical tumor removal
        • indication
          • large tumors or rapidly growing tumors
  • Complications
    • Hearing loss
    • Brainstem compression
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