Vestibular schwannoma (acoustic neuroma)

About 8% of tumors that occur inside the skull are vestibular schwannomas. These tumors are slow-growing and benign, so they sometimes don’t cause symptoms. Your Advocate Health Care multidisciplinary team delivers highly skilled care for vestibular schwannoma that is personalized to your wellbeing and preferences.

What is a vestibular schwannoma?

Vestibular schwannoma risk factors and genetics

Most vestibular schwannomas (95%) occur in only one ear. People who have a one-sided vestibular schwannoma usually don’t have a family history of these tumors.

When both ears are affected by a vestibular schwannoma, they’re often related to a genetic condition called neurofibromatosis type 2 (NF2). People who have NF2 have often had a previous glioma tumor, cataract or meningioma tumor. Double-sided vestibular schwannoma tumors are more common:

• If tumors are discovered before the age of 30
• If a close family member also has NF2

The cause of vestibular schwannoma tumors isn’t known. Research shows that they tend to be related to mutations of a gene located on chromosome 22.

Symptoms of a vestibular schwannoma

Vestibular schwannoma tumors usually grow slowly over a period of years. Vestibular schwannoma symptoms may also begin slowly or they may appear suddenly.

The trigeminal nerve, which controls muscles in the face, is next to the vestibular nerve. When this type of benign tumor on the vestibular nerve grows large enough, it may cause pressure on the trigeminal nerve and cause facial symptoms.

About 90% of people who are diagnosed with a vestibular schwannoma experience loss of hearing in one ear. Some other common vestibular schwannoma symptoms are:

• Ringing or buzzing in the ear (tinnitus)

• Feeling of fullness in the ear

• Balance problems

• Weakness of facial muscles

• Headaches

• Fatigue

• Eye problems

• Cognitive or emotional issues

• Oral or swallowing issues

Any of these vestibular schwannoma symptoms may change over time. If the tumor grows big enough to press on areas of the brain, it may become life-threatening.

Vestibular schwannoma diagnosis

When you see your primary care doctor or neurologist, they’ll start with a physical exam and medical history and ask about your symptoms. They’ll also check some neurological responses such as your reflexes and balance. Tests of your hearing and vision will be recommended, such as:

• Audiogram, a procedure to test the softest sounds you can hear.
• Auditory brainstem response test, which measures the rate of electric impulses traveling from the inner ear to the brainstem. It’s sometimes called an ABR, BAER or BSER.
• Electronystagmography, a test of eye movements to find out how well the nerves are functioning and to gauge balance.

Imaging tests such as CT or MRI  with contrast dye will be performed to confirm vestibular schwannoma diagnosis. These tests provide 3D images of the tumor and the area around it to help your doctor decide about or plan surgery.

Vestibular schwannoma treatment

Treatment options for a vestibular schwannoma include the possibility of watchful waiting. If an acoustic neuroma tumor is small, slow growing or not causing problematic symptoms, continuing to observe it may be the best option. You’ll be monitored with regularly scheduled imaging scans.

Surgery is recommended for larger tumors or tumors that cause severe symptoms. If the tumor is too close to the trigeminal nerve or parts of the brain, your doctor may not be able to remove the whole tumor.

Robotic radiation surgery may be a better choice when a tumor is too hard to remove with conventional surgery. It allows very precise delivery of radiation to the tumor.

In addition to any of the other approaches, you may receive rehabilitation to help with any balance or hearing problems.