Overview
Vestibular Schwannoma (Acoustic Neuroma)
A vestibular schwannoma (also known as acoustic neuroma, acoustic neurinoma, or acoustic neurilemoma) is a benign, usually slow-growing tumor that develops from the balance and hearing nerves supplying the inner ear. The tumor comes from an overproduction of Schwann cells--the cells that normally wrap around nerve fibers like onion skin to help support and insulate nerves. As the vestibular schwannoma grows, it presses against the hearing and balance nerves, usually causing unilateral (one-sided) or asymmetric hearing loss, tinnitus (ringing in the ear), and dizziness/loss of balance. As the tumor grows, it can interfere with the face sensation nerve (the trigeminal nerve), causing facial numbness. Vestibular schwannomas can also press on the facial nerve (for the muscles of the face) causing facial weakness or paralysis on the side of the tumor.How Is A Vestibular Schwannoma Diagnosed?
Unilateral/asymmetric hearing loss and/or tinnitus and loss of balance/dizziness are early signs of a vestibular schwannoma. Unfortunately, early detection of the tumor is sometimes difficult because the symptoms may be subtle and may not appear in the beginning stages of growth. Also, hearing loss, dizziness, and tinnitus are common symptoms of many middle and inner ear problems (the important point here is that unilateral or asymmetric symptoms are the worrisome ones). Once the symptoms appear, a thorough ear examination and hearing test (audiogram) are essential for proper diagnosis. Computerized tomography (CT) scans, enhanced with intravenous dye (contrast), and magnetic resonance imaging (MRI) are critical in the early detection of a vestibular schwannoma and are helpful in determining the location and size of a tumor and in planning its microsurgical removal.
Treatment
Treatment for vestibular (acoustic) schwannomas is by surgical removal through a retro-sigmoid craniotomy or other skull base approach or by radiosurgery. For tumors under 2.5 cm, either surgery or radiosurgery are reasonable treatment options. For tumors over 2.5 cm, surgical removal is generally recommended.Treatment for trigeminal schwannomas is typically by surgical removal through a retro-sigmoid craniotomy or other skull base approach, depending upon the location.
In some patients with a vestibular or trigeminal schwannoma in whom only a sub-total tumor removal is possible, radiosurgery or stereotactic radiotherapy may be effectively used to control further tumor growth.
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