ACOUSTIC NEUROMA

dr Ika Yuliartanti.,SpTHT-KL.,M.Kes

INTRODUCTION
Represent 10% of all intracranial tumors.
Vestibular schwannomas (=acoustic
neuromas) 78% of CPA vestibular
branch of the 8
th
cranial nerve.
STAGING
VESTIBULAR SCHWANOMA
Autopsy series: 1,7% to 2,7% of
undiagnosed & clinically silent
Incidence of 0.7 to 1/100.000 population
arise from the vestibular segment of the
8
th
nerve from schwann cells (the
most commonly)
TUMOR BIOLOGY

The molecular genetics:
Occur as a sporadic variety (95%)
Bilateral in case of type 2 neurofibromatosis
Younger patient & in association with other
intracranial meningioma & spinal cord tumor.
Genetic defect: autosomal dominant & long
arm of chromosome 22.
Symptoms
Related to tumor size & growth.
Intracanalicular: HL, tinnitus, & vestibular
dysfunction
CPA: Severe HL & dysequilibrium
Brainstem: Midfacial hypesthesia,
hydrocephalus, headache, & visual loss.
Hearing Loss
Unilateral HL (> 85%)
Loss of speech discrimination (the most
common)
Tinnitus (second) : (56%) unilateral
vascular occlusion of the labyrinthine
artery

Sudden SNHL (26%)
Vestibular symptoms
Dysequlibrium 56%
Vogue
Transientlight headness
Menieres disease (spread into labyrinth)
Other symptoms
Facial numbness N V-2 (maxillaris)
Occular symptoms diplopia or
visual blurring
Cerebellar involvement late
Incoordination, fall
toward the affected side
Audiometric testing
65% High tone SNHL & 5% normal
hearing
Speech discrimination score
Acoustic-reflex threshold & decay
ABR (the most sensitive & specific)

DIAGNOSTIC TESTING
VESTIBULAR TESTING
ENG
Dynamic postulography
Rotary chair testing
Caloric test
Spontaneous nystagmus large tumor
IMAGING
Plain film
CT scan
MRI
contrast
iophendylate
contrast
air cisternography
Gadolinum DTPA
63% accurate a convex bulge of a mass
MANAGEMENT

1. Preserve life
2. Avoid serious neurologic sequele
3. Complete tumor removal
4. Preserve facial nerve function
5. Preserve hearing

SURGERY
Primary treatment
A team: a neurosurgeon &
neurootologist
Use of microsurgical technique &
intraoperative monitoring of the facial
nerve

Middle Cranial Fossa Approach
Retrosigmoid Approach
Complications:
Facial nerve paralysis (the most
common)
Leakage of LCS (4% to 14%)
Meningitis rare