Acoustic neuroma (also known as a vestibular schwannoma) 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. Vestibular schwannomas are slow growing and are rarely life threatening.
This type of tumour grows along the eighth cranial nerve in the brain, also known as the acoustic or vestibulocochlear nerve. As the nerve controls hearing and balance, loss of hearing in one ear, or problems with balance, are common symptoms. 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.
Vestibular schwannomas can sometimes be difficult to diagnose and their symptoms can be similar to other conditions such as Ménière's disease, a condition that affects the inner ear causing progressive deafness and attacks of tinnitus and vertigo.
Key symptoms include:
Larger tumours may lead to increased pressure in the brain, in turn causing headaches and blurred or double vision. If the tumour presses on the facial nerve (trigeminal nerve), it can cause facial numbness and tingling. Even with treatment, symptoms such as tinnitus and hearing loss can persist. These symptoms will require additional treatment.
If you have a suspected vestibular schwannoma, your doctors need to 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.
Magnetic resonance imaging (MRI) is the preferred diagnostic test to identify these tumour times. If you are having an MRI scan, you will be asked if you have a pacemaker, any implants, such as a programmable shunt or skull section, or if you are likely to have any metal in your body due to working in the steel or metal industries. If you have, then an MRI may not be suitable for you as it uses magnetic fields to take images. Your radiographer will be able to tell you more.
When an MRI cannot be performed, a computerized tomography (CT) scan with contrast is suggested.
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:
Generally, the treatment approaches taken include 'watch and wait', surgery or stereotactic radiotherapy.
Some vestibular schwannomas 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. You might begin treatment if:
Depending on your tumour and age, this could take many years, or not happen at all.
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.
Smaller tumours or parts of a tumour that were unable to be removed by surgery may be treated with stereotactic radiotherapy (SRT). This treatment uses X-ray beams to more accurately target the tumour from different angles. The beams intersect at the tumour site, maximising the dose of radiation there and destroying tumour cells. SRT can be given over multiple sessions (fractionated stereotactic radiotherapy or FSRT), or it can be given in one session (stereotactic radiosurgery or SRS). SRS does not involve actual surgery. Not all brain tumours are suitable to be treated with SRT or SRS - conventional radiotherapy is more appropriate in some cases.
The cause of vestibular schwannomas 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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