Acoustic Neuroma

NAME: KRUNAL VIMALBHAI RAJPARA

PASSPORT NO.:N2334646
CIU
Background
 Originate from vestibular
branch of acoustic nerve
 Histological feature:
schwanoma, neuroma,
neurolemmoma
 Predilection: 30-50y
 Unilateral: majority
 Bilateral: Type II acoustic
neuroma
Pathology
Predominate: internal
auditory canal
Extension to CPA
Compression on brainstem
and brain hydrops
Anterior: trigeminal
nerve,
Medial: abducent nerve
Inferior: IX, X, XI, XII
Clinical presentations
Hearing loss and tinnitus
Progressive HL 90%
SDS reduction
10% of patients complain of sudden HL.
Unbalance
Otalgia and compression due to depression of
sensor fiber of facial nerve
Involvement of trigeminal nerve
Compression of cerebellum and brainstem: ataxia,
nystagmus and intracranial hypo-pressure
Work-up
Audiometry
PTA: threshold elevated in high frequency
tone decay test: positive
Speech audiometry
Acoustic impedance
ABR: latency of wave V prolongs, or wave V disappears
Acoustic emission
Work-up
Vestibular function:
Neurologic exam
Image study
CT shows enlargement of
internal auditory canal
MRI
Managements
Surgery
Middle cranionectomy:
useful hearing
Translabyrinectomy:
 no useful hearing
 Nice exposure of facial nerve
Managements
Retro-sigmoid sinus approach:
Inferior occipital approach:
 Big tumor >3cm
 Nice exposure tumor
Managements
No surgical intervention
-Knife
observation
THANK YOU