Acoustic neuroma Acoustic neuroma

Chunfu Dai N.D S Ph.D Chunfu Dai N.D S Ph.D

ackground ackground
Originate from vestibular Originate from vestibular
branch of aucoustic nerve branch of aucoustic nerve
Histologic feature: Histologic feature:
schwanoma, neuroma, schwanoma, neuroma,
neurolemmoma neurolemmoma
Predilection: 30 Predilection: 30S0y S0y
Unilateral: majority Unilateral: majority
ilateral: Type !! acoustic ilateral: Type !! acoustic
neuroma neuroma
Pathology Pathology
Predominate: internal Predominate: internal
auditory canal auditory canal
Extension to CPA Extension to CPA
Compression on Compression on
brainstem and brain brainstem and brain
hydrops hydrops
Anterior: trigeminal Anterior: trigeminal
nerve, nerve,
Nedial: abducent Nedial: abducent
nerve nerve
!nferior: !X, X, X!, X!! !nferior: !X, X, X!, X!!
Clinical presentations Clinical presentations
Hearing loss and tinnitus Hearing loss and tinnitus
Progressive HL 30 Progressive HL 30
SDS reduction SDS reduction
10 of patients complain of sudden HL. 10 of patients complain of sudden HL.
Unbalance Unbalance
Otalgia and compression due to depression of Otalgia and compression due to depression of
sensor fiber of facial nerve sensor fiber of facial nerve
!nvolvement of trigeminal nerve !nvolvement of trigeminal nerve
Compression of cerebellum and brainstem: Compression of cerebellum and brainstem:
ataxia, nystagmus and intracranial hypo ataxia, nystagmus and intracranial hypo
pressure pressure
ork orkup up
Audiometry Audiometry
PTA: threshold elevated in high frequency PTA: threshold elevated in high frequency
tone decay test: positive tone decay test: positive
Speech audiometry Speech audiometry
Acoustic impedance Acoustic impedance
A%: latency of wave v prolongs, or wave v A%: latency of wave v prolongs, or wave v
disappears disappears
Acoustic emission Acoustic emission
ork orkup up
vestibular function: vestibular function:
Neurologic exam Neurologic exam
!mage study !mage study
CT shows enlargement CT shows enlargement
of internal auditory of internal auditory
canal canal
N%! N%!
Nanagements Nanagements
Surgery Surgery
Niddle cranionectomy: Niddle cranionectomy:
useful hearing useful hearing
Translabyrinectomy: Translabyrinectomy:
no useful hearing no useful hearing
Nice exposure of facial Nice exposure of facial
nerve nerve
Nanagements Nanagements
%etro %etrosigmoid sinus approach: sigmoid sinus approach:
!nferior occipital approach: !nferior occipital approach:
ig tumor >3cm ig tumor >3cm
Nice exposure tumor Nice exposure tumor
Nanagements Nanagements
No surgical No surgical
intervention intervention
Knife Knife
observation observation