Overview
Also known as an acoustic neuroma, vestibular schwannomas are tumours of the vestibulocochlear nerve (CN VIII). They usually grow from the vestibular component of CN VIII and present with unilateral sensory neurone loss.
The name acoustic neuroma is technically a misnomer, as the tumour arises from Schwann cells from the vestibular portion of CN VIII.
Epidemiology
- Vestibular schwannomas are the most common tumour arising at the cerebellopontine angle
- Bilateral vestibular schwannomas are seen in neurofibromatosis type 2 (NF2)
Presentation
Unilateral sensorineural hearing loss should be considered a vestibular schwannoma until proven otherwise. The classic presentation is a combination of:
- Vertigo
- Hearing loss
- Tinnitus
- Involvement of other cranial nerves which may include:
- The trigeminal nerve (CN V): absent corneal reflex
- The facial nerve (CN VII): facial nerve palsy
Investigations
- All patients should urgently be referred to ENT
- MRI of the cerebellopontine angle:
- The investigation of choice
- Pure-tone audiometry:
- Used to assess the degree and severity of hearing loss
Management
Overview
Management depends on the growth pattern of the vestibular schwannoma. Observation, radiotherapy, or surgery may be considered.
Complications
- Cranial nerve palsy
- Hearing loss
- Headaches
- Obstructive hydrocephalus – this may be life-threatening
Prognosis
- Recurrence is uncommon after surgery
