Acoustic Neuroma

Also known as

 Vestibular Schwannoma
 Neurilemmoma
 Eighth Nerve Tumour
Incidence

 80% of all Cerebellopontine angle tumours

 10% of all brain tumours
Pathology

 Benign
 Encapsulated
 Extremely slow growing
 Bilateral tumours present in neurofibromatosis patients
Microscopy

 Elongated spindle cells

 Rod shaped nuclei
 Lying in rows or palisades
Origin and Growth of Tumour

The tumor commonly arises from the Schwann cells of

vestibular division of VIIIth nerve within the internal
auditory canal.
As it expands, it causes widening and erosion of the canal and then
appears in the Cerebellopontine angle.
Here, it may grow anterosuperiorly to involve Vth nerve
Or inferiorly to involve IXth, Xth and XIth cranial nerves.
In later stages, it causes displacement of brainstem,
pressure on cerebellum and raised intracranial pressure.
Classification

Based on size of the tumour.

 Intracanalicular(when it is confined to internal auditory
canal)
 Small size (up to 1.5 cm)
 Medium size(1.5 cm to 4 cm)
 Large size (over 4 cm)
Clinical Features

Age: 40 – 60 years

Sex: Both sexes are equally affected.

Cochleovestibular symptoms

 Earliest symptoms
 Tumour is still intracanalicular
 Cause by pressure on cochlear or vestibular nerve fibres
or on the internal auditory artery.
Cochlear Symptoms -
1. Progressive unilateral sensorineural hearing loss
2. Tinnitus
3. Marked difficulty in understanding speech
4. Out of proportion to pure tone hearing loss –
characteristic feature
Vestibular Symptoms –
5. Imbalance or unsteadiness
6. True vertigo is seldom seen.
Cranial Nerve Involvement

 Vth nerve:
1. Earliest nerve to be involved.
2. It indicates that the tumour is roughly 2.5 cm in
diameter and occupies the Cerebellopontine angle.
3. Symptoms are reduced corneal sensitivity, and
4. Numbness of face
 VIIth Nerve:
1. Sensory fibres are affected early.
2. There is hypoaesthesia of posterior meatal wall
(Hitzelberger’s sign)
3. Loss of taste (tested by electrogustometry)
4. Reduced lacrimation on Schirmer test
5. Delayed blink reflex is a motor symptom
 IXth and Xth Nerves:
1. Paralysis of Palatal, pharyngeal and laryngeal muscles
2. This causes dysphagia and hoarseness of voice.

 Other Cranial Nerves :

1. XIth, XIIth, IIIrd, IVth and VIth are affected when
tumour is very large.
Brainstem Involvement

 Ataxia
 Weakness and Numbness of limbs
 Exaggerated tendon reflexes seen when long motor and
Sensory tracts are involved.
Cerebellar involvement

 Cerebellar symptoms like

 Dysdiadochokinesia
 Ataxic gait
 Inability to walk along a straight line with tendency to
fall to the affected side
 Inability to perform finger-nose test and knee-heel test
Raised intracranial pressure

 Late feature
 There is headache, nausea, vomiting and diplopia due to
VIth nerve involvement
 And there is papilloedema with blurring of vision.
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