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Vestibular Schwannoma
H. Ric Harnsberger, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • 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 that wrap vestibular branches of CNVIII in CPA-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. 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
                                            2. 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
                                            3. 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
                                            4. 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
                                            5. Fukuoka S et al: Gamma knife radiosurgery for vestibular schwannomas. Prog Neurol Surg. 22:45-62, 2009
                                            6. 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
                                            7. Ferri GG et al: Conservative management of vestibular schwannomas: an effective strategy. Laryngoscope. 118(6):951-7, 2008
                                            8. House JW et al: False-positive magnetic resonance imaging in the diagnosis of vestibular schwannoma. Otol Neurotol. 29(8):1176-8, 2008
                                            9. 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
                                            10. 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
                                            11. 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
                                            12. 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
                                            13. 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
                                            14. Furuta S et al: Prediction of the origin of intracanalicular neoplasms with high-resolution MR imaging. Neuroradiology. 47(9):657-63, 2005
                                            15. Lin D et al: The prevalence of "incidental" acoustic neuroma. Arch Otolaryngol Head Neck Surg. 131(3):241-4, 2005
                                            16. 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
                                            17. Darrouzet V et al: Vestibular schwannoma surgery outcomes: our multidisciplinary experience in 400 cases over 17 years. Laryngoscope. 114(4):681-8, 2004
                                            18. Kobayashi M et al: Distance from acoustic neuroma to fundus and a postoperative facial palsy. Laryngoscope. 112(1):168-71, 2002
                                            19. 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
                                            20. Gillespie JE: MRI screening for acoustic neuroma. Br J Radiol. 73(874):1129-30, 2000
                                            21. 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
                                            22. 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
                                            23. 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

                                                  • Pathology

                                                    • 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 that wrap vestibular branches of CNVIII in CPA-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. 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
                                                                                      2. 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
                                                                                      3. 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
                                                                                      4. 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
                                                                                      5. Fukuoka S et al: Gamma knife radiosurgery for vestibular schwannomas. Prog Neurol Surg. 22:45-62, 2009
                                                                                      6. 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
                                                                                      7. Ferri GG et al: Conservative management of vestibular schwannomas: an effective strategy. Laryngoscope. 118(6):951-7, 2008
                                                                                      8. House JW et al: False-positive magnetic resonance imaging in the diagnosis of vestibular schwannoma. Otol Neurotol. 29(8):1176-8, 2008
                                                                                      9. 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
                                                                                      10. 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
                                                                                      11. 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
                                                                                      12. 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
                                                                                      13. 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
                                                                                      14. Furuta S et al: Prediction of the origin of intracanalicular neoplasms with high-resolution MR imaging. Neuroradiology. 47(9):657-63, 2005
                                                                                      15. Lin D et al: The prevalence of "incidental" acoustic neuroma. Arch Otolaryngol Head Neck Surg. 131(3):241-4, 2005
                                                                                      16. 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
                                                                                      17. Darrouzet V et al: Vestibular schwannoma surgery outcomes: our multidisciplinary experience in 400 cases over 17 years. Laryngoscope. 114(4):681-8, 2004
                                                                                      18. Kobayashi M et al: Distance from acoustic neuroma to fundus and a postoperative facial palsy. Laryngoscope. 112(1):168-71, 2002
                                                                                      19. 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
                                                                                      20. Gillespie JE: MRI screening for acoustic neuroma. Br J Radiol. 73(874):1129-30, 2000
                                                                                      21. 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
                                                                                      22. 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
                                                                                      23. 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