Summary
Definition
History and exam
Key diagnostic factors
- asymmetric hearing loss
- progressive episodes of dizziness
- tinnitus
Other diagnostic factors
- difficulty localizing sounds
- headache
- facial numbness
- facial weakness
- diplopia on lateral gaze
- nystagmus
- loss of balance and coordination difficulties
- slower blink
- swallowing difficulties
- gait disturbances
- hydrocephalus
- papilledema
- increased intracranial pressure
Risk factors
- neurofibromatosis-related schwannomatosis
Diagnostic tests
1st tests to order
- audiogram
- T1-weighted MRI using gadolinium-based contrast
- contrast-enhanced head CT
Tests to consider
- auditory brainstem reflexes
Treatment algorithm
small tumor (Koos grades 1-2)
medium tumor (Koos grades 3-4, tumor size <3 cm)
large tumor (Koos grade 4, tumor size >3 cm)
Contributors
Authors
Michael J. Link, MD
Professor
Departments of Neurologic Surgery and Otorhinolaryngology
Mayo Clinic
Rochester
MN
Disclosures
MJL is an author of a reference cited in this topic.
Matthew L. Carlson, MD
Professor
Departments of Neurologic Surgery and Otorhinolaryngology
Mayo Clinic
Rochester
MN
Disclosures
MLC is an author of a reference cited in this topic.
Acknowledgements
Dr Michael J. Link and Dr Matthew L. Carlson would like to gratefully acknowledge Dr Ryojo Akagami, the previous contributor to this topic.
Disclosures
RA has been reimbursed for instructing at a dissection course by Stryker and gives yearly lectures at a Canadian resident review course. RA was an expert panelist at a session on vestibular schwannomas at the 2019 NASBS meeting.
Peer reviewers
Rick Friedman, MD, PhD
Professor of Otolaryngology and Neurosurgery
UC San Diego
La Jolla
CA
Disclosures
RF declares that he has no competing interests.
Iain Swan, MD, FRCS
Senior Lecturer in Otolaryngology
Honorary Consultant Otolaryngologist
Glasgow Royal Infirmary
Glasgow
UK
Disclosures
IS declares that he has no competing interests.
Patrice Tran Ba Huy, MD
Department of Otorhinolaryngology-Head and Neck Surgery
AP-HP
Hopital Lariboisiere
Service ORL
Universite Paris 7
Paris and Laboratoire des Réseaux Sensorimoteurs
Paris
France
Disclosures
PTBH declares that he has no competing interests.
References
Key articles
Goldbrunner R, Weller M, Regis J, et al. EANO guideline on the diagnosis and treatment of vestibular schwannoma. Neuro Oncol. 2020 Jan 11;22(1):31-45.Full text Abstract
Ren Y, Chari DA, Vasilijic S, et al. New developments in neurofibromatosis type 2 and vestibular schwannoma. Neurooncol Adv. 2021 Jan-Dec;3(1):vdaa153.Full text Abstract
Lin VY, Stewart C, Grebenyuk J, et al. Unilateral acoustic neuromas: long-term hearing results in patients managed with fractionated stereotactic radiotherapy, hearing preservation surgery, and expectantly. Laryngoscope. 2005 Feb;115(2):292-6. Abstract
Pollock BE. Management of vestibular schwannomas that enlarge after stereotactic radiosurgery: treatment recommendations based on a 15 year experience. Neurosurgery. 2006 Feb;58(2):241-8. Abstract
Darrouzet V, Martel J, Enee V, et al. Vestibular schwannoma surgery outcomes: our multidisciplinary experience in 400 cases over 17 years. Laryngoscope. 2004 Apr;114(4):681-8. Abstract
Roland JT Jr, Fishman AJ, Golfinos JG, et al. Cranial nerve preservation in surgery for large acoustic neuromas. Skull Base. 2004 May;14(2):85-91.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Meningioma
- Epidermoid cyst
- Facial nerve schwannoma
More DifferentialsGuidelines
- EANO guideline on the diagnosis and treatment of vestibular schwannoma
- Guidelines on the management of patients with vestibular schwannoma
More GuidelinesPatient information
Tinnitus
More Patient information
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