A benign slow-growing tumour, which, following detection, usually remains stable.
Unilateral sensorineural hearing loss is the most common symptom, followed by intermittent dizziness and facial numbness.
Larger tumours may cause headaches, coordination difficulties, and obstructive hydrocephalus, and, as a result, may be life threatening.
Diagnosis is confirmed by gadolinium-enhanced magnetic resonance imaging scan.
Management includes observation, focused radiation, or surgery.
Treatment options and outcome vary depending on local expertise and patient preference.
A benign cerebellopontine angle tumour that grows from the superior vestibular component of the vestibulocochlear nerve, usually presenting with unilateral sensorineural hearing loss. Vestibular schwannomas are also called acoustic neuromas, and the two terms may be used interchangeably. However, acoustic neuroma is a misnomer, because the tumour actually grows on the vestibular component and is pathologically a schwannoma. Tumours can enlarge significantly to cause cerebellar findings and obstructive hydrocephalus, and may become life threatening as a result.
History and exam
Key diagnostic factors
- asymmetrical hearing loss
- facial numbness
- progressive episodes of dizziness
Other diagnostic factors
- difficulty localising sounds
- facial weakness
- increased or decreased tears
- metallic or reduced taste
- diplopia on lateral gaze
- loss of balance and coordination difficulties
- slower blink
- swallowing difficulties
- gait disturbances
- increased intracranial pressure
- neurofibromatosis type 2
1st investigations to order
- gadolinium-enhanced MRI head
- CT head
- auditory brainstem reflexes
tumour <1 to 1.5 cm
tumour 1.5 to 3 cm
tumour >3 cm
- Facial nerve schwannoma
- Suspected cancer: recognition and referral
- Guidelines on the management of patients with vestibular schwannoma
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