An acoustic neuroma is better known as a vestibular schwannoma. It is simply a tumour arising from the Schwann cells that myelinate the vestibular nerve (CN8).
The vestibular nerve is a portion of the vestibulocochlear nerve which provides hearing and balance and courses through the internal acoustic meatus before arriving at the pons at the cerebellopontine angle.
Vestibular schwannomas are generally unilateral tumours, that are slow growing (1-2mm annually) and benign. We can sometimes see bilateral vestibular schwannomas in neurofibromatosis type 2.
They are seen more commonly in females and account for 5% of intracranial tumours and about 90% of cerebellopontingle angle tumours.
😷 Presentation
- 40-60 years old mostly
- Aural fullness - sensation of blockage in the ear
Depending on the cranial nerves affected, the features may be:
- Absent corneal reflex
- Facial palsy
- Unilateral hearing loss - it is a sensorineural form of hearing loss.
- Vertigo - once again unilaterally
- Unilateral tinnitus
🔍 Investigations
🧰 Management
An urgent ENT review is needed, despite it being slow growing and benign.
It can be managed in one of 3 ways:
- Conservatively - simply keep an eye on it and assess if patient becomes symptomatic.
- Surgically - either total or partial removal of tumour.
- Radiotherapy - to reduce the size of the tumour and buy time.
