Management of Vestibular Schwannoma

Abstract

Vestibular schwannoma (VS) is considered histologically a benign tumor and is currently preferred over the older term (Acoustic neuroma) as it usually arises from the inferior division of the vestibular nerve and not the acoustic nerve in the cerebellopontine angle. (VS) Is one of the most common intra cranial tumors, comprising 8-10% of tumors in most series. Annual incidence is probably about 1.5 cases per 100,000 population, over the past couple decades this estimate has increased and the typical size at the initial diagnosis has decreased as a result of the advances in the MRI scans & CT scan qualities, (VS) is found to be occurring among middle age groups with no gender prevalence in the fourth or fifth decade. The diagnosis of the disease depends mainly on the clinical picture which mostly starts by a sensory neural hearing loss in the diseased ear verified by audiometry and other radio-investigation, adjacent cranial nerves can be affected by continuous tumor growth, the tumor may reach a large size that can cause a secondary hydrocephalus & increased intra cranial pressure or even can cause compression to the nearby brain stem and damage to its long tracts passing through. Treatment options of (VS) include observational follow up, radiation therapy, and microsurgical removal via one of several approaches or even a combined treatment modality guided by the size, rate of growth, the clinical state and the general condition of the patient in addition to his own will in approving or choosing the treatment.