Introduction

Vestibular schwannomas (sometimes referred to as acoustic neuromas) account for approximately 5% of intracranial tumours and 90% of cerebellopontine angle tumours.

Epidemiology

  • Incidence: 1.00 cases per 100,000 person-years
  • Peak incidence: 50-60 years
  • Sex ratio: 1:1
<1 1-5 6+ 16+ 30+ 40+ 50+ 60+ 70+ 80+

Pathophysiology

Bilateral vestibular schwannomas are seen in neurofibromatosis type 2.

Clinical features

The classical history of vestibular schwannoma includes a combination of vertigo, hearing loss, tinnitus and an absent corneal reflex. Features can be predicted by the affected cranial nerves:
  • cranial nerve VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus
  • cranial nerve V: absent corneal reflex
  • cranial nerve VII: facial palsy

Referral criteria

Patients with a suspected vestibular schwannoma should be referred urgently to ENT. It should be noted though that the tumours are often slow growing, benign and often observed initially.

Investigations

MRI of the cerebellopontine angle is the investigation of choice. Audiometry is also important as only 5% of patients will have a normal audiogram.

Management

Management is with either surgery, radiotherapy or observation.