Abstract
VS account for approximately 6–8% of intracranial tumors in adults and are the most common tumor in the CPA ranging between 80% and 95%. Vestibular schwannomas constitute 6% of all intracranial neoplasms and are the most common benign lesions of the IAC and CPA cistern constituting between 60% and 90% of the entire lesions seen in this area. Growth rates in tumors that exhibit enlargement have been reported to be about 1–2 mm per year in linear growth in at least one dimension. While no formal consensus exists, most authors define normal growth rates as being between 1 and 2 mm per year and fast growth rates as 4 mm or greater per year. When considering common presenting manifestations, a helpful framework is to consider manifestations based on the size of the tumor, and its location; intracanalicular, cisternal, brainstem compressive, or hydrocephalic sizes. While any configuration is possible, hearing loss associated with vestibular schwannomas of this size is typically unilateral, progressive, and commonly affects high-frequency thresholds and speech perception. An occipital headache attributable to the tumor is a late finding with 20% of patients with tumors between 1 and 3 cm, with 40% of patients with tumors larger than 3 cm verifying this symptom. Gross total resection is the goal of surgery while maintaining good facial function, in all sizes of tumors, and hearing preservation, in small to moderate size tumors in patients with serviceable preoperative hearing status.
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Khrais T, Romano G, Sanna M. Nerve origin of vestibular schwannoma: a prospective study. J Laryngol Otol. 2008;122(2):128–31.
Angelika Z, et al. Management of benign cranial nonacoustic schwannomas by fractionated stereotactic radiotherapy. Int J Cancer. 2001;96(6):356–62.
Lin EP, Crane BT. The management and imaging of vestibular schwannomas. AJNR Am J Neuroradiol. 2017;38(11):2034–43.
Mahaley MS Jr, et al. Analysis of patterns of care of brain tumor patients in the United States: a study of the Brain Tumor Section of the AANS and the CNS and the Commission on Cancer of the ACS. Clin Neurosurg. 1990;36:347–52.
Horváth M, et al. Tumors of the cerebellopontine angle. Changing policy in treatment. Neurosurg Rev. 1996;19(4):243–6.
Betka J, et al. Complications of microsurgery of vestibular schwannoma. Biomed Res Int. 2014;2014:315952.
Moffat DA, Ballagh RH. Rare tumours of the cerebellopontine angle. Clin Oncol. 1995;7(1):28–41.
Springborg JB, Poulsgaard L, Thomsen J. Nonvestibular schwannoma tumors in the cerebellopontine angle: a structured approach and management guidelines. Skull Base. 2008;18(4):217–27.
Hasegawa M, et al. Cerebellopontine angle epidermoid cysts: clinical presentations and surgical outcome. Neurosurg Rev. 2016;39(2):259–66. discussion 266–7.
Ramsden RT. The bloody angle: 100 years of acoustic neuroma surgery. J R Soc Med. 1995;88(8):464P–8P.
Cushing H. Tumors of the nervus acusticus and the syndrome of the cerebellopontine angle. Philadelphia: Saunders; 1917.
Brackmann DE. Vestibular schwannoma (acoustic neuroma). Otolaryngol Clin N Am. 2012;45(2):xiii–xv.
Pellet W. History of vestibular schwannoma surgery. Prog Neurol Surg. 2008;21:6–23.
Koerbel A, et al. Evolution of vestibular schwannoma surgery: the long journey to current success. Neurosurg Focus. 2005;18(4):e10.
Alfaifi A, et al. The top 50 most-cited articles on acoustic neuroma. World Neurosurg. 2018;111:e454–64.
Dandy WE. Removal of cerebellopontile (acoustic) tumors through a unilateral approach. Arch Surg. 1934;29(3):337–44.
Horrax G, Poppen JL, Strain RE. Results of present day operations for acoustic tumors. Lahey Clin Bull. 1949;6(4):109–11.
House WF. Transtemporal bone microsurgical removal of acoustic neuromas. evolution of transtemporal bone removal of acoustic tumors. Arch Otolaryngol. 1964;80:731–42.
Hitselberger WE, House WF. Surgical approaches to acoustic tumors. Arch Otolaryngol. 1966;84(3):286–91.
Brackmann DE, Bartels LJ. Rare tumors of the cerebellopontine angle. Otolaryngol Head Neck Surg (1979). 1980;88(5):555–9.
Marcel Maya M, Lo WWM, Kovanlikaya I. Temporal bone: tumor and cerebellopontine angle lesions. In: Som PM, Curtin HD, editors. Head and neck imaging. St. Louis, MO: Mosby; 2003.
Propp JM, et al. Descriptive epidemiology of vestibular schwannomas. Neuro-Oncology. 2006;8(1):1–11.
Lee A, Chao S, Murphy E. Acoustic neuroma. Appl Radiat Oncol. 2013;2(1):24–6.
Evans DGR, Birch JM, Ramsden RT. Paediatric presentation of type 2 neurofibromatosis. Arch Dis Child. 1999;81(6):496–9.
Howitz MF, et al. Incidence of vestibular schwannoma in Denmark, 1977-1995. Am J Otol. 2000;21(5):690–4.
Nestor JJ, et al. The incidence of acoustic neuromas. Arch Otolaryngol Head Neck Surg. 1988;114(6):680.
Tos M, et al. What is the real incidence of vestibular schwannoma? Arch Otolaryngol Head Neck Surg. 2004;130(2):216–20.
Abele TA, et al. Diagnostic accuracy of screening MR imaging using unenhanced axial CISS and coronal T2WI for detection of small internal auditory canal lesions. AJNR Am J Neuroradiol. 2014;35(12):2366–70.
Liudahl AA, et al. Diagnosis of small vestibular schwannomas using constructive interference steady state sequence. Laryngoscope. 2018. https://doi.org/10.1002/lary.27100.
Anderson TD, et al. Prevalence of unsuspected acoustic neuroma found by magnetic resonance imaging. Otolaryngol Head Neck Surg. 2000;122(5):643–6.
Lin D, et al. The prevalence of “incidental” acoustic neuroma. Arch Otolaryngol Head Neck Surg. 2005;131(3):241–4.
Stangerup SE, Caye-Thomasen P. Epidemiology and natural history of vestibular schwannomas. Otolaryngol Clin N Am. 2012;45(2):257–68, vii.
M, H. and C. SJ. Early asymptomatic acoustic tumor. Report of six cases. Arch Surg. 1936;32:292–301.
Leonard JR, Talbot ML. Asymptomatic acoustic neurilemoma. Arch Otolaryngol. 1970;91(2):117–24.
Stangerup SE, et al. True incidence of vestibular schwannoma? Neurosurgery. 2010;67(5):1335–40. discussion 1340.
Lee KS, et al. The proliferative activity of neurilemomas. Surg Neurol. 1989;32(6):427–33.
Lesser TH, et al. Clinical growth rate of acoustic schwannomas: correlation with the growth fraction as defined by the monoclonal antibody ki-67. Skull Base Surg. 1991;1(1):11–5.
Bederson JB, et al. Conservative treatment of patients with acoustic tumors. Neurosurgery. 1991;28(5):646–50. discussion 650–1.
Kesterson L, et al. Clinical behavior of acoustic tumors. A flow cytometric analysis. Arch Otolaryngol Head Neck Surg. 1993;119(3):269–71.
Pasquier B, et al. Evaluation of the acoustic neuroma growth rate by immunohistochemical techniques. In: Tos M, Thomsen J, editors. Proceeding of the first international conference on acoustic neuroma, Amsterdam; 1992. p. 173–6.
Nedzelski JM, et al. Conservative management of acoustic neuromas. Otolaryngol Clin N Am. 1992;25(3):691–705.
Selesnick SH, Johnson G. Radiologic surveillance of acoustic neuromas. Am J Otol. 1998;19(6):846–9.
Battaglia A, Mastrodimos B, Cueva R. Comparison of growth patterns of acoustic neuromas with and without radiosurgery. Otol Neurotol. 2006;27(5):705–12.
Mirz F, et al. Incidence and growth pattern of vestibular schwannomas in a Danish county, 1977-98. Acta Otolaryngol Suppl. 2000;543:30–3.
Shin YJ, et al. Effectiveness of conservative management of acoustic neuromas. Am J Otol. 2000;21(6):857–62.
Hoistad DL, et al. Update on conservative management of acoustic neuroma. Otol Neurotol. 2001;22(5):682–5.
Tschudi DC, Linder TE, Fisch U. Conservative management of unilateral acoustic neuromas. Am J Otol. 2000;21(5):722–8.
Strasnick B, et al. The natural history of untreated acoustic neuromas. Laryngoscope. 1994;104(9):1115–9.
Bakkouri WE, et al. Conservative management of 386 cases of unilateral vestibular schwannoma: tumor growth and consequences for treatment. J Neurosurg. 2009;110(4):662–9.
Baser M, et al. Evaluation of genotype-phenotype correlations for vestibular schwannoma growth rates in neurofibromatosis 2. In: Fourth international conference on vestibular schwannoma and other CPA lesions, Cambridge, England; 2003.
Lanser M, Jackler R, Pitts L. Intratumoral hemorrhage and cyst expansion as causes of acute neurological deterioration in acoustic neuroma patients. In:Proceeding of the first international conference on acoustic neuroma. Amsterdam: Kugler; 1992.
Stangerup SE, et al. The natural history of vestibular schwannoma. Otol Neurotol. 2006;27(4):547–52.
Hunter JB, et al. Single institutional experience with observing 564 vestibular schwannomas: factors associated with tumor growth. Otol Neurotol. 2016;37(10):1630–6.
Stangerup SE, et al. Change in hearing during ‘wait and scan’ management of patients with vestibular schwannoma. J Laryngol Otol. 2008;122(7):673–81.
Stangerup SE, et al. Long-term hearing preservation in vestibular schwannoma. Otol Neurotol. 2010;31(2):271–5.
Stangerup SE, et al. Hearing outcomes of vestibular schwannoma patients managed with ‘wait and scan’: predictive value of hearing level at diagnosis. J Laryngol Otol. 2010;124(5):490–4.
Elliott A, et al. Hearing preservation in vestibular schwannoma management. Am J Otolaryngol. 2015;36(4):526–34.
Matthies C, Samii M. Management of 1000 vestibular schwannomas (acoustic neuromas): clinical presentation. Neurosurgery. 1997;40(1):1–9. discussion 9–10.
Harner SG, Fabry DA, Beatty CW. Audiometric findings in patients with acoustic neuroma. Am J Otol. 2000;21(3):405–11.
Thomsen J, Tos M. Acoustic neuroma: clinical aspects, audiovestibular assessment, diagnostic delay, and growth rate. Am J Otol. 1990;11(1):12–9.
Selesnick SH, Jackler RK. Atypical hearing loss in acoustic neuroma patients. Laryngoscope. 1993;103(4 Pt 1):437–41.
Edwards CH, Paterson JH. A review of the symptoms and signs of acoustic neurofibromata. Brain. 1951;74(2):144–90.
Simon C, Brichet B, Decroocq F. An electromyographic study of the facial nerve and its innervation territy by detection, stimulo-detection, and blink reflex in preoperative acoustic neuroma. In:Proceeding of the First International Conference on Acoustic Neuroma. Amsterdam: Kugler; 1992.
Zubay G, Porter RW, Spetzler RF. Neurofibromatosis. Oper Tech Neurosurg. 2001;4(1):43–6.
Rouleau GA, et al. Alteration in a new gene encoding a putative membrane-organizing protein causes neuro-fibromatosis type 2. Nature. 1993;363:515.
Obremski VJ, Hall AM, Fernandez‐Valle C. Merlin, the neurofibromatosis type 2 gene product, and β1 integrin associate in isolated and differentiating Schwann cells. J Neurobiol. 1998;37(4):487–501.
Prasad SC, et al. Decision making in the wait-and-scan approach for vestibular schwannomas: is there a price to pay in terms of hearing, facial nerve, and overall outcomes? Neurosurgery. 2017. https://doi.org/10.1093/neuros/nyx568.
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Dogan, I., Ozaydin, B., Roche, J.P., Baskaya, M.K. (2019). Acoustic Neuromas: General Considerations. In: Vestibular Schwannoma Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-99298-3_1
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