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Acoustic neuroma
Vestibular schwannoma, also known as acoustic neuroma, is a benign, slow-growing tumor of the vestibulocochlear nerve. It is most commonly located in the internal acoustic meatus and cerebellopontine angle. Clinical presentation varies depending on the size and location of the tumor, but may include hearing loss, tinnitus, imbalance, and cranial nerve involvement. Diagnosis is made through audiological tests, vestibular tests, neurological examination, and MRI. Surgical resection is the primary treatment, with approaches depending on tumor size and extent. Radiosurgery is also used for smaller tumors. Complications can include hearing loss, facial nerve palsy, and balance
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Acoustic neuroma
- 1. Vestibular schwannoma Acoustic Neuroma Int.Sunder Chapagain
- 2.
- 3. Cerebellopontine angle • Location-almosttriangular space located In posterior cranial fossa and contains CSF • Relations- Central structures- CNVII & CNVIII Superiorly- CNV Inferiorly-CNIX,CNX &CNXI
- 4. Vestibular Schwanoma • Vestibularneuroma is a benign, slow growing, encapsulated tumor of vestibulocochlear (8th CN) cranial nerve. • It is also known as -Acoustic neuroma -Acoustic neurilomma -CPA tumor -Angle tumor
- 5. Epidemiology • 10 in1 millions • In USA-2000-30000 cases are diagnosed each year • 95%-Sporadic • 5%- associated with NF2-usually bilateral-early incidence • Epidemiological classification 1.silent tumors 2. symptomatic undiagnosed tumors 3.diagnosed tumors
- 6. Classification • According tosize of tumor a. intracanalicular- confined with in IAC b. small size- (up to 1.5 cm) c. medium size- (1.5-4 cm) d. large size- (>4 cm)
- 7. Classification Jackler classification Intrameatal tumourExtrameatal size mm Grade 1 Small 1-10 Grade 2 Medium 11-20 Grade 3 Moderately large 21-30 Grade 4 Large 31-40 Grade 5 Giant >40
- 8. Pathogenesis • Growth pattern •Intrameatal compression • Extrameatal compression
- 10. Pathology • Gross -Small tolarge size -encapsulated -slowly growing -medial to IAC and lateral to CPA • Microscopic -Antoni A cells -Antoni B cells
- 11.
- 12. Clinical Presentation 1. Ageand sex 2. Vestibulocochlear symptoms 3. Cranial nerve involvement 4. Brainstem involvement 5. Cerebellar involvement 6. Raised ICP
- 13. • Vestibulocochlear symptoms -Hearingloss-sensoryneural,usually unilateral -tinnitis -unsteadyness • Cranial nerve involvement 7th CN-Hitzelberger’s sign -loss of taste sensation -reduced lacrimation -delayed blink reflex
- 14. 5th CN -numbness of face -reduced corneal reflex 9th & 10th CN-dysphasia -horseness of voice 11th & 12th ,3rd, 4th, 6th CN –if tumor is very large • Brainstem involvement -ataxia -weakness and numness of arms and legs -exagerated tendon reflex
- 15. • Cerebeller involvement -ataxicgait -postural imalance -asynergia -dysmetria -adiadochokinesia • Raised ICP- Headache, vomiting,diplopia papiloedema,bluring of vision
- 16.
- 17. History • unilateral orbilateral sensorineural hearing loss, tinnitus with(out) imbalance
- 18. Investigation • Audiological tests –PTA – Speech audiometry(SD score) – Roll over phenomenon – Recruitment phenomenon – Short Increment Sensitivity Index(SISI) – Threshold tone decay test – Stapedial Reflex Decay Test – Brain stem evoked response audiometry
- 19.
- 20. Brain stem evokedresponse audiometry
- 21. • Vestibular Tests –Caloric test • Neurological tests – Cranial nerves – Cerebellar functions – Brainstem signs
- 22. • Radiological tests –Plain X-rays – CT scan – Gadolinium Enhanced MRI • most sensitive • Gold standard – Vertebral Angiography • CSF analysis
- 23. DDx • Meningioma • Cochlearpathology(meniere’s disease) • Lipoma • Epidermoid • Cholesterol granuloma • Cholesteatoma • Arachnoid cyst • Aneurysm • Metastasis • Schwannoma of other cranial nerves(V,VII,IX,X and XI)
- 24.
- 25. Surgical • 1st treatmentof choice • Surgical approach depends upon size and extent of tumor. • Approaches: – Middle cranial fossa approach – Translabyrinthine approach – Suboccipital(retrosigmoid) approach – Combined translabyrinthine-suboccipital approach
- 26. Post operative complications •Common: SNHL,temporary facial nerve palsy and balance problem, CSF leak, meningitis • Rare: stroke, intracranial bleeding, pneumocephalus, cerebellar ataxia, and even death.
- 27. Radiological • X-knife orGamma knife surgery- 2nd treatment of choice • Cyber knife
- 28.
Editor's Notes
- #3 Tc… tranverse canal BB-Bill’s bar