ACOUSTIC NEUROMA

Vestibular schwannomas are benign, encapsulated tumors that arise from schwann cells of vestibular nerve Most of vestibular schwannomas originate in the region of the internal auditory canal Constitutes 80% of all CP angle tumors and 10% of all brain tumors

Cerebellopontine angle

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Vestibular schwannoma
Classification
Growth of tumor Classification- Intracanalicular Small (upto 1.5 cm) Medium (1.5 to 4 cm) Large (over 4 cm)

Vestibular schwannoma
Origin-Schwann cells of vestibular nerve

Vestibular schwannoma
Clinical Features:Age and sex. 40 to 60 years Progressive unilateral sensorineural hearing loss Tinnitus Difficulty to understand speech Vertigo/imbalance Cranial nerve involvement Brainstem involvement Cerebellar involvement

Vestibular schwannoma Clinical Features

Acoustic neuroma

Vestibular schwannoma
Investigations: Pure tone audiometry Speech audiometry Recruit phenomenon SISI Index Threshold tone decay test Caloric test RADIOLOGICAL TESTS; Plain x-rays CT Scan

Vestibular schwannoma
MRI SCAN

Tests to differentiat cochlear from retro cochlear pathology

Tests Normal Cochlear Retro cochlear

PTA S.D.S Recruitment SISI score TDT SR BERA

Normal 90 to 100% absent 0 to 15% 0to 15 dB Normal Normal

S.N.loss Below 90% present >70% <25 dB normal abnormal

S.N.loss poor absent 0 to 205 > 25 dB abnormal abnormal

Vestibular schwannoma
Differential Diagnosis

Vestibular schwannoma
TREATMENT Careful serial observation. surgical excision of the tumor Arresting tumor growth using stereotactic radiation therapy