Vestibular schwannomas (sometimes referred to as acoustic neuromas) account for approximately 5% of intracranial tumours and 90% of cerebellopontine angle tumours.
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:
Bilateral vestibular schwannomas are seen in neurofibromatosis type 2.
Dx
Schwann cell origin, S-100 ⊕. Biphasic, dense, hypercellular areas containing spindle cells alternating with hypocellular, myxoid areas.
MRI of the cerebellopontine angle is the investigation of choice. Audiometry is also important as only 5% of patients will have a normal audiogram.
Vestibular schwannoma at the right cerebellopontine angle - e Image used on license from Radiopaedia
MRI showing a vestibular schwannoma - e Image used on license from Radiopaedia
Mx
Management is with either surgery, radiotherapy or observation.
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.