A vestibular schwannoma is a benign subarachnoid tumour that causes local pressure effects on the VIII cranial nerve

Vestibular schwannomas account for approximately 5% of intracranial tumours and 90% of cerebellopontine angle tumours.

PC

• The most common symptoms reported include asymmetric or unilateral hearing loss and progressive ipsilateral tinnitus.
• Other symptoms include: dizziness, headaches and disequilibirum.

Features can be predicted by the affected cranial nerves:

• cranial nerve VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus
• cranial nerve V: absent corneal reflex
• cranial nerve VII: facial palsy

Bilateral vestibular schwannomas are seen in neurofibromatosis type 2.

Investigations

Patients with a suspected vestibular schwannoma should be referred urgently to ENT. It should be noted though that the tumours are often slow growing, benign and often observed initially.

• Gadolinium enhances MRI of the cerebellopontine angle is the investigation of choice.
• Audiometry is also important as only 5% of patients will have a normal audiogram.

Management

• Over 40mm require surgery.