Acoustic neuroma

Acoustic neuroma

Vestibular schwannoma- Tumor - acoustic- Cerebellopontine angle tumor- Angle tumor

An acoustic neuroma is a slow-growing tumor of the nerve that connects the ear to the brain. This nerve is called the vestibular cochlear nerve. It is behind the ear right under the brain.

An acoustic neuroma is not cancerous (benign), which means it does not spread to other parts of the body. However, it can damage several important nerves as it grows.

Causes, incidence, and risk factors

Acoustic neuromas have been linked with the genetic disorder neurofibromatosis type 2 (NF2).

Acoustic neuromas are relatively uncommon.

Symptoms

The symptoms vary based on the size and location of the tumor. Because the tumor grows so slowly, symptoms usually start after the age of 30.

Common symptoms include:

Abnormal sensation of movement (vertigo)

Hearing loss in the affected ear that makes it hard to hear conversations

Ringing (tinnitus) in the affected ear

Less common symptoms include:

Difficulty understanding speech

Dizziness

Headache

Upon waking up in the morning

Wakes you from sleep

Worse when lying down

Worse when standing up

Worse when coughing, sneezing, straining, or lifting (Valsalva maneuver)

With nausea or vomiting

Loss of balance

Numbness in the face or one ear

Pain in the face or one ear

Sleepiness

Vision problems

Weakness of the face

Signs and tests

The health care provider may diagnose an acoustic neuroma based on your medical history, an examination of your nervous system, or tests.

Often, the physical exam is normal at the time the tumor is diagnosed. Occasionally, the following signs may be present:

Drooling

Facial drooping on one side

Unsteady walk

Dilated pupil on one side only (See: Eyes, pupils different size)

The most useful test to identify an acoustic neuroma is an MRI of the head. Other useful tests to diagnose the tumor and tell it apart from other causes of dizziness or vertigo include:

Head CT

Hearing test (audiology)

Test of equilibrium and balance (electronystagmography)

Test of hearing and brainstem function (brainstem auditory evoked response)

Test for vertigo (caloric stimulation)

Treatment

Treatment depends on the size and location of the tumor, your age, and overall health. You and your health care provider must decide whether to watch the tumor (observation), use radiation to stop it from growing, or try to remove it.

Many acoustic neuromas are small and grow very slowly. Small tumors with few or no symptoms may be followed, particularly in older patients. Regular MRI scans will be done.

If they are not treated, some acoustic neuromas can damage the nerves involved in hearing and balance, as well as the nerves responsible for movement and feeling in the face. Very large tumors can lead to a buildup of fluid (hydrocephalus) in the brain, which can be life-threatening.

Removing an acoustic neuroma is more commonly done for:

Larger tumors

Tumors that are causing symptoms

Tumors that are growing quickly

Tumors that are growing near a nerve or part of the brain that is more likely to cause problems

Surgery is done to remove the tumor and prevent other nerve damage. Any remaining hearing is often lost with surgery.

Stereotactic radiosurgery focuses high-powered x-rays on a small area. It is considered to be a form of radiation therapy, not a surgical procedure. It may be used:

To slow down or stop the growth of tumors that are hard to remove with surgery

To treat patients who are unable to have surgery, such as the elderly or people who are very sick

Removing an acoustic neuroma can damage nerves, causing loss of hearing or weakness in the face muscles. This damage is more likely to occur when the tumor is next to or around the nerves.

Expectations (prognosis)

An acoustic neuroma is not cancer. The tumor does not spread (metastasize) to other parts of the body. However, it may continue to grow and press on important structures in the skull.

People with small, slow-growing tumors may not need treatment.

Once hearing loss occurs, it does not return after surgery.

Complications

Brain surgery can completely remove the tumor in most cases.

Most people with small tumors will have no permanent paralysis of the face after surgery. However, about two-thirds of patients with large tumors will have some permanent facial weakness after surgery.

Approximately one-half of patients with small tumors will still be able to hear well in the affected ear after surgery.

There may be delayed radiation effects after radiosurgery, including nerve damage, loss of hearing, and paralysis of the face.

Calling your health care provider

Call your health care provider if you experience new or worsening hearing loss, ringing in your ears, or vertigo (dizziness).