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Vestibular Schwannoma
Philip R. Chapman, MD; H. Ric Harnsberger, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Vestibular schwannoma (VS)
          • Synonyms

            • Acoustic schwannoma, acoustic neuroma, acoustic tumor
              • Uncommon names: Neurinoma, neurilemmoma
          • Definitions

            • Benign tumor arising from Schwann cells of vestibular branches of CNVIII in cerebellopontine angle (CPA)-internal auditory canal (IAC)

          IMAGING

          • General Features

            • CT Findings

              • MR Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Staging, Grading, & Classification

                        • Gross Pathologic & Surgical Features

                          • Microscopic Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        • Reporting Tips

                                          Selected References

                                          1. Goldbrunner R et al: EANO guideline on the diagnosis and treatment of vestibular schwannoma. Neuro Oncol. 22(1):31-45, 2020
                                          2. González-Darder JM et al: Magnetic resonance imaging surveillance for vestibular schwannoma after microsurgical resection using a retrosigmoid transmeatal approach. World Neurosurg. 139:e585-91, 2020
                                          3. Gupta VK et al: Vestibular schwannoma: what we know and where we are heading. Head Neck Pathol. 14(4):1058-66, 2020
                                          4. Van Gompel JJ et al: Congress of neurological surgeons systematic review and evidence-based guidelines on emerging therapies for the treatment of patients with vestibular schwannomas. Neurosurgery. 82(2):E52-4, 2018
                                          5. Oh JH et al: Clinical application of 3D-FIESTA image in patients with unilateral inner ear symptom. Korean J Audiol. 17(3):111-7, 2013
                                          6. Tomogane Y et al: Usefulness of PRESTO magnetic resonance imaging for the differentiation of schwannoma and meningioma in the cerebellopontine angle. Neurol Med Chir (Tokyo). 53(7):482-9, 2013
                                          7. Bakkouri WE et al: Conservative management of 386 cases of unilateral vestibular schwannoma: tumor growth and consequences for treatment. J Neurosurg. 110(4):662-9, 2009
                                          8. Fortnum H et al: The role of magnetic resonance imaging in the identification of suspected acoustic neuroma: a systematic review of clinical and cost effectiveness and natural history. Health Technol Assess. 13(18):iii-iv, ix-xi, 1-154, 2009
                                          9. Fukuoka S et al: Gamma knife radiosurgery for vestibular schwannomas. Prog Neurol Surg. 22:45-62, 2009
                                          10. Bhadelia RA et al: Increased cochlear fluid-attenuated inversion recovery signal in patients with vestibular schwannoma. AJNR Am J Neuroradiol. 29(4):720-3, 2008
                                          11. Ferri GG et al: Conservative management of vestibular schwannomas: an effective strategy. Laryngoscope. 118(6):951-7, 2008
                                          12. House JW et al: False-positive magnetic resonance imaging in the diagnosis of vestibular schwannoma. Otol Neurotol. 29(8):1176-8, 2008
                                          13. Meijer OW et al: Tumor-volume changes after radiosurgery for vestibular schwannoma: implications for follow-up MR imaging protocol. AJNR Am J Neuroradiol. 29(5):906-10, 2008
                                          14. Thamburaj K et al: Intratumoral microhemorrhages on T2*-weighted gradient-echo imaging helps differentiate vestibular schwannoma from meningioma. AJNR Am J Neuroradiol. 29(3):552-7, 2008
                                          15. Jacob A et al: Nerve of origin, tumor size, hearing preservation, and facial nerve outcomes in 359 vestibular schwannoma resections at a tertiary care academic center. Laryngoscope. 117(12):2087-92, 2007
                                          16. Maire JP et al: Twenty years' experience in the treatment of acoustic neuromas with fractionated radiotherapy: a review of 45 cases. Int J Radiat Oncol Biol Phys. 66(1):170-8, 2006
                                          17. Okamoto K et al: Focal T2 hyperintensity in the dorsal brain stem in patients with vestibular schwannoma. AJNR Am J Neuroradiol. 27(6):1307-11, 2006
                                          18. Furuta S et al: Prediction of the origin of intracanalicular neoplasms with high-resolution MR imaging. Neuroradiology. 47(9):657-63, 2005
                                          19. Lin D et al: The prevalence of "incidental" acoustic neuroma. Arch Otolaryngol Head Neck Surg. 131(3):241-4, 2005
                                          20. Myrseth E et al: Vestibular schwannomas: clinical results and quality of life after microsurgery or gamma knife radiosurgery. Neurosurgery. 56(5):927-35; discussion 927-35, 2005
                                          21. Darrouzet V et al: Vestibular schwannoma surgery outcomes: our multidisciplinary experience in 400 cases over 17 years. Laryngoscope. 114(4):681-8, 2004
                                          22. Kobayashi M et al: Distance from acoustic neuroma to fundus and a postoperative facial palsy. Laryngoscope. 112(1):168-71, 2002
                                          23. Dubrulle F et al: Cochlear fossa enhancement at MR evaluation of vestibular Schwannoma: correlation with success at hearing-preservation surgery. Radiology. 215(2):458-62, 2000
                                          24. Gillespie JE: MRI screening for acoustic neuroma. Br J Radiol. 73(874):1129-30, 2000
                                          25. Nakamura H et al: Serial follow-up MR imaging after gamma knife radiosurgery for vestibular schwannoma. AJNR Am J Neuroradiol. 21(8):1540-6, 2000
                                          26. Zealley IA et al: MRI screening for acoustic neuroma: a comparison of fast spin echo and contrast enhanced imaging in 1233 patients. Br J Radiol. 73(867):242-7, 2000
                                          27. Allen RW et al: Low-cost high-resolution fast spin-echo MR of acoustic schwannoma: an alternative to enhanced conventional spin-echo MR? AJNR Am J Neuroradiol. 17(7):1205-10, 1996
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Abbreviations

                                                    • Vestibular schwannoma (VS)
                                                  • Synonyms

                                                    • Acoustic schwannoma, acoustic neuroma, acoustic tumor
                                                      • Uncommon names: Neurinoma, neurilemmoma
                                                  • Definitions

                                                    • Benign tumor arising from Schwann cells of vestibular branches of CNVIII in cerebellopontine angle (CPA)-internal auditory canal (IAC)

                                                  IMAGING

                                                  • General Features

                                                    • CT Findings

                                                      • MR Findings

                                                        • Imaging Recommendations

                                                          DIFFERENTIAL DIAGNOSIS

                                                            PATHOLOGY

                                                            • General Features

                                                              • Staging, Grading, & Classification

                                                                • Gross Pathologic & Surgical Features

                                                                  • Microscopic Features

                                                                    CLINICAL ISSUES

                                                                    • Presentation

                                                                      • Demographics

                                                                        • Natural History & Prognosis

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Consider

                                                                              • Image Interpretation Pearls

                                                                                • Reporting Tips

                                                                                  Selected References

                                                                                  1. Goldbrunner R et al: EANO guideline on the diagnosis and treatment of vestibular schwannoma. Neuro Oncol. 22(1):31-45, 2020
                                                                                  2. González-Darder JM et al: Magnetic resonance imaging surveillance for vestibular schwannoma after microsurgical resection using a retrosigmoid transmeatal approach. World Neurosurg. 139:e585-91, 2020
                                                                                  3. Gupta VK et al: Vestibular schwannoma: what we know and where we are heading. Head Neck Pathol. 14(4):1058-66, 2020
                                                                                  4. Van Gompel JJ et al: Congress of neurological surgeons systematic review and evidence-based guidelines on emerging therapies for the treatment of patients with vestibular schwannomas. Neurosurgery. 82(2):E52-4, 2018
                                                                                  5. Oh JH et al: Clinical application of 3D-FIESTA image in patients with unilateral inner ear symptom. Korean J Audiol. 17(3):111-7, 2013
                                                                                  6. Tomogane Y et al: Usefulness of PRESTO magnetic resonance imaging for the differentiation of schwannoma and meningioma in the cerebellopontine angle. Neurol Med Chir (Tokyo). 53(7):482-9, 2013
                                                                                  7. Bakkouri WE et al: Conservative management of 386 cases of unilateral vestibular schwannoma: tumor growth and consequences for treatment. J Neurosurg. 110(4):662-9, 2009
                                                                                  8. Fortnum H et al: The role of magnetic resonance imaging in the identification of suspected acoustic neuroma: a systematic review of clinical and cost effectiveness and natural history. Health Technol Assess. 13(18):iii-iv, ix-xi, 1-154, 2009
                                                                                  9. Fukuoka S et al: Gamma knife radiosurgery for vestibular schwannomas. Prog Neurol Surg. 22:45-62, 2009
                                                                                  10. Bhadelia RA et al: Increased cochlear fluid-attenuated inversion recovery signal in patients with vestibular schwannoma. AJNR Am J Neuroradiol. 29(4):720-3, 2008
                                                                                  11. Ferri GG et al: Conservative management of vestibular schwannomas: an effective strategy. Laryngoscope. 118(6):951-7, 2008
                                                                                  12. House JW et al: False-positive magnetic resonance imaging in the diagnosis of vestibular schwannoma. Otol Neurotol. 29(8):1176-8, 2008
                                                                                  13. Meijer OW et al: Tumor-volume changes after radiosurgery for vestibular schwannoma: implications for follow-up MR imaging protocol. AJNR Am J Neuroradiol. 29(5):906-10, 2008
                                                                                  14. Thamburaj K et al: Intratumoral microhemorrhages on T2*-weighted gradient-echo imaging helps differentiate vestibular schwannoma from meningioma. AJNR Am J Neuroradiol. 29(3):552-7, 2008
                                                                                  15. Jacob A et al: Nerve of origin, tumor size, hearing preservation, and facial nerve outcomes in 359 vestibular schwannoma resections at a tertiary care academic center. Laryngoscope. 117(12):2087-92, 2007
                                                                                  16. Maire JP et al: Twenty years' experience in the treatment of acoustic neuromas with fractionated radiotherapy: a review of 45 cases. Int J Radiat Oncol Biol Phys. 66(1):170-8, 2006
                                                                                  17. Okamoto K et al: Focal T2 hyperintensity in the dorsal brain stem in patients with vestibular schwannoma. AJNR Am J Neuroradiol. 27(6):1307-11, 2006
                                                                                  18. Furuta S et al: Prediction of the origin of intracanalicular neoplasms with high-resolution MR imaging. Neuroradiology. 47(9):657-63, 2005
                                                                                  19. Lin D et al: The prevalence of "incidental" acoustic neuroma. Arch Otolaryngol Head Neck Surg. 131(3):241-4, 2005
                                                                                  20. Myrseth E et al: Vestibular schwannomas: clinical results and quality of life after microsurgery or gamma knife radiosurgery. Neurosurgery. 56(5):927-35; discussion 927-35, 2005
                                                                                  21. Darrouzet V et al: Vestibular schwannoma surgery outcomes: our multidisciplinary experience in 400 cases over 17 years. Laryngoscope. 114(4):681-8, 2004
                                                                                  22. Kobayashi M et al: Distance from acoustic neuroma to fundus and a postoperative facial palsy. Laryngoscope. 112(1):168-71, 2002
                                                                                  23. Dubrulle F et al: Cochlear fossa enhancement at MR evaluation of vestibular Schwannoma: correlation with success at hearing-preservation surgery. Radiology. 215(2):458-62, 2000
                                                                                  24. Gillespie JE: MRI screening for acoustic neuroma. Br J Radiol. 73(874):1129-30, 2000
                                                                                  25. Nakamura H et al: Serial follow-up MR imaging after gamma knife radiosurgery for vestibular schwannoma. AJNR Am J Neuroradiol. 21(8):1540-6, 2000
                                                                                  26. Zealley IA et al: MRI screening for acoustic neuroma: a comparison of fast spin echo and contrast enhanced imaging in 1233 patients. Br J Radiol. 73(867):242-7, 2000
                                                                                  27. Allen RW et al: Low-cost high-resolution fast spin-echo MR of acoustic schwannoma: an alternative to enhanced conventional spin-echo MR? AJNR Am J Neuroradiol. 17(7):1205-10, 1996