Vestibular schwannoma (acoustic neuroma)
- John K Park, MD, PhD
John K Park, MD, PhD
- Santa Barbara Neuroscience Institute
- David M Vernick, MD
David M Vernick, MD
- Assistant Professor of Otolaryngology
- Harvard Medical School
- Naren Ramakrishna, MD, PhD
Naren Ramakrishna, MD, PhD
- Director of Neuro and Pediatric Radiation Oncology
- University of Florida Health Cancer Center at Orlando Health
- Professor of Radiation Oncology
- University of Central Florida College of Medicine
- Section Editors
- Jay S Loeffler, MD
Jay S Loeffler, MD
- Section Editor — Neurooncology
- Professor of Radiation Oncology
- Harvard Medical School
- Patrick Y Wen, MD
Patrick Y Wen, MD
- Section Editor — Neurooncology
- Professor of Neurology
- Harvard Medical School
Vestibular schwannomas (also known as acoustic neuromas, acoustic schwannomas, acoustic neurinomas, or vestibular neurilemomas) are Schwann cell-derived tumors that commonly arise from the vestibular portion of the eighth cranial nerve (figure 1).
Vestibular schwannomas account for approximately 8 percent of intracranial tumors in adults and 80 to 90 percent of tumors of the cerebellopontine angle (CPA). In comparison, they are rare in children, except for patients with neurofibromatosis type 2 (NF2). (See "Neurofibromatosis type 2".)
The epidemiology, pathogenesis, clinical presentation, diagnosis, and management of patients with vestibular schwannomas will be reviewed here.
The overall incidence of vestibular schwannomas is about one per 100,000 person-years. However, the incidence appears to be increasing, due at least in part to the incidental diagnosis of asymptomatic lesions with the widespread use of magnetic resonance imaging (MRI) and computed tomography [1,2]. As an example, a retrospective analysis of 46,000 MRI scans done for other reasons identified eight unsuspected vestibular schwannomas (0.02 percent) , and autopsy studies suggest that the prevalence may be even higher [3,4].
The median age at diagnosis is approximately 50 years . The tumors are unilateral in more than 90 percent of cases , affecting the right and left sides with equal frequency. Bilateral vestibular schwannomas are primarily limited to patients with neurofibromatosis type 2 . (See "Neurofibromatosis type 2", section on 'Vestibular schwannomas'.)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- PATHOGENESIS AND RISK FACTORS
- CLINICAL PRESENTATION
- Physical examination
- Vestibular testing
- - Surgical techniques
- - Outcomes
- - Other complications
- Radiation therapy
- - Stereotactic radiosurgery
- - Stereotactic radiotherapy
- - Proton beam therapy
- POSTTREATMENT FOLLOW-UP
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS