What’s up with Acoustic

Neuromas?

Nancy Fuller, M.D.

PCC September 27, 2006
Objectives:

-Recognize signs and symptoms of

acoustic neuroma

-Identify treatment options and their risks

-no financial disclosures

• Patient #1: 2 year history of right sided
hearing loss.
-sudden worsening: near total
deafness

• A diagnostic test was performed.

• Patient #2: history of migraine
headaches; new onset dizziness after
treatment for status migrainus.

• A diagnostic treatment was performed.

• MRI # 1: 12 x 4 mm intracanalicular
enhancing lesion c/w acoustic
schwannoma (acoustic neuroma)

• MRI #2: 11x 6 mm cerebellopontine

angle enhancing lesion c/w acoustic
schwannoma
 Acoustic Neuroma
aka: Acoustic Schwannoma
Acoustic neurinoma
Vestibular schwannoma
Vestibular neurilemoma

Schwann cell derived tumor usually arising

from vestibular portion of vestibulocochlear
nerve, aka acoustic nerve (VIII)
• 1/100,000 person-years

• 8% of intracranial tumors

• 80-90% of cerebellopontine angle tumors

• Increasing frequency-
? Incidentalomas
? Exposure to loud noise
? Exposure to radiofrequencies (cell phones)
• Either superior or inferior branches of
8th nerve

• Variable natural history: approx. 2 mm

growth per year BUT
-40 % of tumors-no growth or even
shrinkage in serial imaging studies

• No predictive relationship between

growth rate and tumor size
• Clinical presentation: due to cranial nerve
involvement and tumor progression

• 95% acoustic nerve involvement (others

facial nerve, etc)-95% hearing loss present,
63% tinnitus

• Acute sensorineural hearing loss is unusual

in AN, but AN is a common cause of
sensorineural hearing loss
• Vestibular portion of nerve: 61%

• Symptoms include unsteadiness,

vertigo

• Other symptoms from compression of

facial nerve and trigeminal nerve
• Diagnosis: asymmetric sensorineural
hearing loss + MRI or CT, with
audiometry showing speech loss out of
proportion to decreased hearing

• PE: Rinne test-tuning fork to mastoid

Weber test-tuning fork to skull
• TX: Surgery
Radiation Therapy
Observation

-Surgery-usually collaboration between

neurosurg and ENT

-big learning curve

-Only rarely does hearing improve after surgery;

half of patients lose more hearing

-nearly 100% successful in eliminating tumor

-Radiation: ‘gamma knife’ or linear accelerator
used

-good alternative especially for small tumors

-?scarring may complicate future surgery if

needed, but overall outcome is similar

-fewer complications such as headaches, facial

weakness, vestibular dysfunction
-Observation:

MRI q 6-12 months

Potential problem: observation may

result in higher likelihood of hearing
loss, so if hearing is still present, earlier
treatment is preferred