For your Patients from – Vestibular Schwannoma (Acoustic Neuroma)

September 2020 – Vol. 39, No. 8

Vestibular schwannoma is a benign (non-cancerous) tumor that grows on the eighth cranial nerve, which is responsible for hearing and balance. The tumors are rare, accounting for only 5-7% of all brain tumors. However, for the part of the brain where they are located, called the cerebellopontine angle, it is the most common tumor type.

The annual incidence of being diagnosed with a vestibular schwannoma is one per 100,000 people, with approximately 3,000 newly diagnosed tumors each year in the United States. This number may be rising as our ability to detect smaller tumors has improved. The tumor grows on the eighth cranial nerve, which travels from the inner ear to the brainstem to communicate hearing and balance information to the brain. The nerve has three distinct parts that connect to the inner ear: the superior and inferior vestibular (balance) nerves and the cochlear (hearing) nerve, which come together at the brainstem.

Vestibular schwannomas are also referred to as acoustic neuromas. It was once believed that the tumor originated on the cochlear portion of the eighth cranial nerve because hearing loss is often the first symptom. We now know that the tumor most often arises from one of the vestibular portions of the eighth cranial nerve, therefore the more accurate name is vestibular schwannoma. Both names are still commonly used and refer to the same tumor.

Vestibular schwannomas come in different sizes and cause a variety of problems. This tumor does not spread (metastasize) nor does it invade the brain, but if large enough, it can push on and squeeze the brain.

What Are the Symptoms of a Vestibular Schwannoma?

The symptoms of a vestibular schwannoma may include:

  • Sudden or gradual hearing loss (sensorineural hearing loss)
  • Ringing, roaring, buzzing, or hissing in the ears or head, known as tinnitus
  • Ear fullness
  • Vertigo, or feeling like you are spinning when you are still
  • Imbalance, or unsteadiness
  • Headache
  • Facial weakness
  • Facial numbness

What Causes a Vestibular Schwannoma?

The exact cause of most vestibular schwannomas is unknown. Ninety-five percent of tumors occur spontaneously and are found on one side (unilateral) only. A small subset of vestibular schwannomas is associated with a genetic condition called Neurofibromatosis Type 2 (NF2). NF2 is rare and results in bilateral vestibular schwannomas. Regardless of the cause, the tumor originates from Schwann cells, which insulate nerves allowing them to transmit their neural signal quickly. When a tumor develops, the Schwann cells grow too quickly and can damage the nerve. In general, vestibular schwannomas grow slowly with an average growth rate of one to two millimeters per year. However, some tumors do not grow for several years and others grow rapidly.

Researchers continue to look for potential causes of vestibular schwannomas. High-dose therapeutic radiation to the head may increase the risk. Overall, there is no clear evidence that environmental factors, such as cell phones, cause these tumors. The rising incidence of vestibular schwannomas likely relates to improvements in magnetic resonance imaging (MRI) and increased screening for concerning symptoms.

What Are the Treatment Options?

Management of vestibular schwannomas centers around three different options: observation with repeated imaging, radiation, and surgery. The decision is complex and must account for tumor size, hearing status, symptoms, patient health, patient preference, and physician preference. Weighing these factors requires a thorough discussion with your ENT (ear, nose, and throat) specialist, or otolaryngologist, and often referral to additional specialists in neurotology, neurosurgery, and/or radiation-oncology.

Tumors can be classified as small, medium, or large. In general, small tumors are less than 1.5 cm, medium tumors are between 1.5 – 2.5 cm, and large tumors are greater than 2.5 cm. As tumors grow, they tend to cause more problems including hearing loss and compression on the brainstem.

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