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General Medicine

Acoustic Neuroma

Jason E. Cohn, DO, Brian McKinnon, MD, MBA, MPH, FCPP, FACS and Robert T. Sataloff, MD, DMA, FACS Reviewed 06/2019
 


BASICS

DESCRIPTION

Acoustic neuromas (vestibular schwannomas) are slow-growing, benign, intracranial, extra-axial tumors originating from the vestibulocochlear nerve. 

  • Originated from Schwann cells of t...

DIAGNOSIS

HISTORY

  • Common

    • Sensorineural hearing loss (unilateral), often progressive

    • Sudden deafness

    • Loss of speech discrimination

    • Tinnitus

    • Disequilibrium is common, but vertigo is less common.

  • Less common ...

TREATMENT

GENERAL MEASURES

  • Treatment options include observation, stereotactic radiosurgery, fractionated radiotherapy, and microsurgery.

  • Without intervention, 16–26% of patients require additional trea...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Yearly MRI follow-up for slow-growing tumors is advised.

  • MRI and audiometry

  • In one study, composite quality of life (cQOL) score 0 to 5 years out of surgery was sig...

REFERENCES

1
Elliott A, Hebb AL, Walling S, et al. Hearing preservation in vestibular schwannoma management. Am J Otolaryngol.  2015;36(4):526–534. [View Abstract on OvidMedline]
2
Olshan M, Sriniva...

ADDITIONAL READING

  • Bell JR, Anderson-Kim SJ, Low C, et al. The persistence of tinnitus after acoustic neuroma surgery. Otolaryngol Head Neck Surg.  2016;155(2):317–323. [View Abstract on OvidMedl...

CODES

ICD10

D33.3 Benign neoplasm of cranial nerves 

ICD9

225.1 Benign neoplasm of cranial nerves 

SNOMED

126949007 acoustic neuroma (disorder) 

CLINICAL PEARLS

  • The most common presenting signs and symptoms are unilateral sensorineural hearing loss, poor speech discrimination, and tinnitus.

  • May present as sudden deafness

  • MRI with gadolinium is t...

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Related Images
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Fig SK 13-1. Acoustic neuroma. Contrast-enhancing mass (arrow) in the right internal auditory canal and cerebellopontine angle cistern.1
Fig SK 13-1. Acoustic neuroma. Contrast-enhancing mass (arrow) in the right internal auditory canal and cerebellopontine angle cistern.1
FIGURE 114.9 Small intracanalicular acoustic neuroma observed on axial magnetic resonance imaging (arrow). The patient is a 42-year-old man who had reported progressive hearing loss in the right ear. Given his profound preoperative hearing loss, he had this lesion resected through a translabyrinthine approach without preservation of hearing function.
FIGURE 114.9 Small intracanalicular acoustic neuroma observed on axial magnetic resonance imaging (arrow). The patient is a 42-year-old man...
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