Vestibular

Schwannoma
Management
“ Cerebellopontine Angel Tumor “

Khaled Bandar Al-sulaim

 Investigation
A thorough physical exam, including an ear exam, is often the first step in acoustic neuroma
diagnosis and treatment.

Tests :-
 Hearing test (audiometry)
Initial diagnosis as well as subsequent monitoring of disease progression.
It tests both the intensity and the tone of sounds , balance issues , and other issues related to the function
of the inner ear by an audiologist.
It involves using an audiometer, which is a machine that plays sounds via headphones, depending on the
result the audiologist will detect an initial diagnose .

 Imaging (MRI)
If MRI is unavailable or you can't tolerate an MRI scan, computerized tomography (CT) may
be used, but it may miss very small tumors.
 Management\Treatment
 Treatment varies depending on :
1. The size and growth of the acoustic neuroma
2. Your overall health
3. Experiencing symptoms

Treatment Methods
 Monitoring : used in case of
1. small acoustic neuroma that isn't growing or is growing slowly and causes few or no
signs or symptoms.
2. older adult or otherwise not a good candidate for more-aggressive treatment.
Regular imaging and hearing tests, usually every six to 12 months.
-If the scans show the tumor is growing or if the tumor causes progressive symptoms
or other difficulties, you may need to undergo treatment :
 Surgery
 Radiotherapy ( Stereotactic radiosurgery )
 Gamma Knife stereotactic radiosurgery technology uses many small gamma rays to
deliver a precise dose of radiation to a target without damaging the surrounding tissue
or making an incision.
 The goal of surgery is to remove the tumor, preserve the facial nerve to prevent facial
paralysis and preserve hearing when possible.
 Surgery complications may include:
• Leakage of cerebrospinal fluid through the wound
• Hearing loss
• Facial weakness
• Facial numbness
• Ringing in the ear
• Balance problems
• Persistent headache
• Infection of the cerebrospinal fluid (meningitis)
• Stroke or brain bleeding
 It is important not only to stop the growth of the tumour but also to
avoid any degenerative changes in the inner ear.
 In addition to treatment to remove or stop the growth of the tumor,
Supportive therapy, including balance (vestibular) therapy,
physical therapy, occupational therapy and hearing assistance is
part of the comprehensive acoustic neuroma treatment.
 Vestibular schwannomas can also affect the facial nerve (for
the muscles of the face) causing facial weakness or paralysis
on the side of the tumor. If the tumor becomes large, it will
eventually press against nearby brain structures (such as the
brainstem and the cerebellum), becoming life-threatening
 some patients experience hearing loss, cerebrospinal fluid
leak, damage to the nerves in the face and other problems.
 Only about 30 percent of acoustic neuromas show
growth four years after diagnosis. In the remaining 70
percent of cases, we can just watch for a while.
Prognosis
 Recovery time varies from 4 to 6 weeks, depending on your
tumor size and your general health.
 Findings indicate the striking improvements in the prognosis
of surgery for vestibular schwannoma, with a mortality rate of
0.5%.
Thank You