What is a vestibular schwannoma ?

Vestibular schwannoma (also known as a acoustic neuroma) is a low grade brain tumour accounting for 8% of all primary brain tumours. They tend to affect adults between the ages of 30 to 60.

This type of tumour grows along the eighth cranial nerve in the brain, also known as the acoustic or vestibulocochlear nerve. The tumour arises from a type of cell called a schwann cell. Schwann cells wrap themselves around nerves to protect them and support their function.

What are the symptoms of vestibular schwannoma? 

As the nerve controls hearing and balance, loss of hearing in one ear, vertigo or problems with balance, are common symptoms.

How are vestibular schwannoma diagnosed?

If your medical team think you have a vestibular schwannoma, they will find out as much as possible about the position and size of your tumour so they can plan your treatment. 

Routine auditory tests may reveal a loss of hearing and speech decline. An audiogram will be performed to evaluate the level of hearing in both ears and sometimes a test is done to check your sense of balance. The doctor will also test your reflexes and the strength in your arms and legs. 

If there is a noticeable loss of hearing in one ear, a Magnetic Resonance Imaging (MRI) scan will be performed. When an MRI cannot be performed, a computerized tomography (CT) scan with contrast is suggested.

What is the prognosis for vestibular schwannomas?

Vestibular schwannomas  are generally slow growing and are rarely life threatening.

How is a vestibular schwannoma treated?

When you are diagnosed, the most appropriate treatment for you can depend on a number of factors. Things that your medical team will consider when deciding what treatment is right for you can include:

• The size of the tumour
• How the symptoms are affecting you
• Your general health

Generally, the treatment approaches taken include ‘watch and wait’, surgery or stereotactic radiotherapy.

Watch and wait

Some vestibular schwannoma may not need immediate treatment. This is usually when they are small and not causing symptoms. If on ‘watch and wait’, you will see your specialist for regular check ups/MRI scans every 3, 6 or 12 months.

Surgery

Surgery is usually only used to remove larger tumours as it can result in the loss of hearing in the affected ear. Your surgeon will explain what is involved in the procedure and potential risks and complications. The surgeon may leave a small part of the tumour to prevent damage to the facial nerve. Any tumour cells that are left behind can be treated with stereotactic radiosurgery.

You may wish to discuss the possibility of having a ‘bone anchored hearing aid’ with your surgeon. This diverts sound from your affected ear to your good ear. Occasionally surgery can result in damage to the facial nerve, causing your face to droop on one side or difficulty in closing that eye.

What causes vestibular schwannoma?

The cause of vestibular schwannoma is unknown, however around 7% of cases are caused by a rare genetic disorder known as Neurofibromatosis type 2 (NF-2). This type of genetic condition causes low grade tumours to grow along your nerves. NF-2 is caused by a permanent change, or gene mutation, in the DNA sequence that makes up a gene. This in turn means that the growth of nerve tissue can become uncontrolled. In half of all cases of NF-2, the mutation is passed on from one generation the other. i.e. parent to child. Although there are genetic tests that can be carried out during pregnancy to test whether your child will have NF-2, it is normally diagnosed after birth.

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