Vestibular Schwannoma

Vestibular schwannomas (also known as acoustic tumors) are benign growths of the hearing and balance nerve that can cause a variety of ear related symptoms. They are easily diagnosed via an MRI with contrast application and should be suspected with asymmetric hearing impairment (worse hearing on one ear compared to the contralateral side). Symptoms can also include balance complaints, tinnitus, and other brain related problems such as chronic headaches, facial numbness, and visual issues. These brain related symptoms are usually a result of direct brainstem compression or tumor pushing against other nerves.

Most vestibular schwannomas demonstrate little growth tendencies. In rare cases, however, schwannomas are faster growing with maximum growth rates ranging in the 2 mm per year range. Thus, many smaller tumors can be watched before a treatment decision has to be made. With larger tumors featuring brainstem compression, however, more aggressive surgical management is typically indicated. Very important in the treatment decision are quality of life related concerns such as balance and hearing function as well as considerations of the facial nerve. These options should be discussed in great detail with your provider. Besides surgery and watchful waiting, stereotactic radiosurgery is a viable option for small to medium size tumors where treatment is indicated but surgery is not considered.

Due to the complexity of each case, your provider will have a thorough discussion with you about the management algorithms available. Depending on these factors, patients are encouraged to conclude a reasonable management decision with their physician.

MRI of small and large schwannomas

Three main surgical approaches

Stereotactic radiology approach