Summary
Definition
History and exam
Key diagnostic factors
- asymmetrical hearing loss
- facial numbness
- progressive episodes of dizziness
Other diagnostic factors
- tinnitus
- difficulty localising sounds
- headache
- facial weakness
- increased or decreased tears
- metallic or reduced taste
- diplopia on lateral gaze
- nystagmus
- loss of balance and coordination difficulties
- slower blink
- swallowing difficulties
- gait disturbances
- hydrocephalus
- papilloedema
- increased intracranial pressure
Risk factors
- neurofibromatosis type 2
Diagnostic investigations
1st investigations to order
- audiogram
- gadolinium-enhanced MRI head
- CT head
- auditory brainstem reflexes
Treatment algorithm
tumour <1 to 1.5 cm
tumour 1.5 to 3 cm
tumour >3 cm
Contributors
Authors
Ryojo Akagami, BSc, MHsc, MD, FRCS(C), FAANS
Clinical Professor
University of British Columbia
Vancouver Health Sciences Centre
Division of Neurosurgery
Vancouver
British Columbia
Canada
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 NASB meeting.
Peer reviewers
David Rowed, MD
Division of Neurosurgery
University of Toronto
Toronto
Ontario
Canada
Disclosures
DR declares that he has no competing interests.
Laligam N. Sekhar, MD, FACS
Vice Chairman
Professor
Director
Cerebrovascular Surgery
Co-Director
Skull Base Surgery
Department of Neurological Surgery
University of Washington
Harborview Medical Center
Seattle
WA
Disclosures
LNS declares that he has no competing interests.
Renn Holness, MD
Professor
Division of Neurosurgery
Dalhousie University
Halifax
Nova Scotia
Canada
Disclosures
RH declares that she 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.
Differentials
- Meningioma
- Epidermoid
- Facial nerve schwannoma
More DifferentialsGuidelines
- Suspected cancer: recognition and referral
- Guidelines on the management of patients with vestibular schwannoma
More GuidelinesPatient leaflets
Tinnitus
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