Vestibular schwannomas (classically called an acoustic neuroma) are a benign type of brain tumor. Though they are benign and non-cancerous, they can still cause serious complications, including hearing loss, balance problems, and other severe symptoms. Treatment from a neurosurgeon is essential to avoid permanent damage. Centers for Neurosurgery, Spine & Orthopedics (CNSO) is New Jersey’s most comprehensive brain and spine center. Here, CNSO’s medical team discusses how vestibular schwannomas can be treated and when observation may be sufficient.
Quick Facts About Vestibular Schwannomas
- A vestibular schwannoma is a type of benign brain tumor that forms from the vestibular nerve that runs from the cochlear nerve into the inner ear.
- Common symptoms of vestibular schwannoma include hearing loss, tinnitus, vertigo, and fullness in the ear. Large tumors may cause other symptoms as well.
- Some small tumors do not need immediate treatment and can instead be monitored.
- Direct treatments for vestibular schwannoma include surgery and radiation therapy.
What Is a Vestibular Schwannoma?
A schwannoma is a type of benign tumor that forms from Schwann cells, which cover and insulate the nerves. A vestibular schwannoma forms from the vestibular nerve in the inner ear. It is also sometimes called an acoustic neuroma since this type of tumor most often causes hearing loss and was once thought to arise from the cochlear nerve, which is responsible for hearing. Most tumors of this type grow slowly; however, over time, they can cause permanent hearing loss and other severe complications.
What Causes a Vestibular Schwannoma?
Tumors arise from normal cells that have a change in their DNA, losing the signal to stop growing. This uncontrolled growth leads to the formation of a mass or tumor. A vestibular schwannoma is caused by an alteration to the cell DNA of a Schwann cell that is covering the vestibular nerve. The change causes cells to reproduce more rapidly than normal, creating a mass of abnormal cells that slowly continues to grow. There is no known cause for the DNA change that creates a schwannoma, though some cases may be related to a hereditary mutation responsible for neurofibromatosis type 2.
Diagnosing Vestibular Schwannoma
A schwannoma causes symptoms as the tumor grows and presses against nearby structures. Vestibular schwannomas originate from the nerve that supplies balance. The vestibular nerve courses near the cochlear nerve (hearing), from the brainstem to the inner ear. Consequently, early symptoms include tinnitus, hearing loss, and balance issues. Very large tumors may cause other complications as well, depending on what parts of the brain they press against. Symptoms of vestibular schwannoma include:
- Hearing loss, usually on one side
- Tinnitus, or hissing, buzzing, or ringing in the ear
- Feelings of fullness in the ear
- Dizziness or vertigo
- Facial weakness
- Facial twitching
- Tingling sensations or numbness in the face
- Difficulty swallowing
- Hoarse voice
- Changes in taste
- Dry eyes or unexpected tears
- Headaches
When a patient experiences hearing loss, vertigo, or other signs of a vestibular schwannoma, their primary care physician or ear, nose, and throat (ENT) doctor may order imaging that shows a vestibular schwannoma. At that point, most patients will be referred to a specialist for evaluation. The brain tumor specialist will review the patient’s symptoms and medical history. They will also request a series of diagnostic tests to identify the cause of the symptoms. These tests may include:
- Audiometry: Also called a hearing test, this procedure involves directing sounds into one ear at a time to test the patient’s ability to hear different volumes and tones.
- Neurological exam: This is a type of physical exam used to evaluate nerve function, including hearing, sensation, balance, strength, coordination, and muscle control.
- Imaging tests: Specialized computed tomography (CT) and magnetic resonance imaging (MRI) scans are used to better visualize a vestibular schwannoma, determine the location of nearby cranial nerves, and see how much it is affecting the brainstem.
Test results are used to rule out other potential causes of symptoms and arrive at a conclusive diagnosis. They also help physicians determine the size of the schwannoma, its location, and the extent of damage it may have caused, which are all important factors in planning an appropriate treatment.
Vestibular Schwannoma Treatment Approaches
Once a vestibular schwannoma has been diagnosed, the patient and their care team will discuss treatment options. The most appropriate treatment depends on multiple factors, including the tumor’s size, its location, the patient’s symptoms, and their overall health. Options include:
Watchful Waiting
Because vestibular schwannomas are typically slow-growing, immediate treatment is not always necessary. The neurosurgeon may recommend an approach called watchful waiting. This involves monitoring the tumor with regular MRI scans to check for signs of growth and hearing tests to monitor for hearing loss. In the meantime, the patient should also report any new symptoms that develop.
Watchful waiting is recommended for small tumors that do not cause symptoms, or for patients with medical conditions that would make treatment risky. If the tumor grows significantly or begins causing symptoms, then doctors may adopt a more definitive treatment.
Surgical Options
The preferred treatment for vestibular schwannomas is surgical resection. The specific surgical approach is chosen based on the tumor’s size and how much it has impacted the patient’s hearing, with different approaches accessing the tumor from above, behind, or through the temporal bone (inner ear). Once the tumor has been exposed, the neurosurgeon removes as much of it as possible.
Surgery cannot correct hearing loss, facial weakness, or other consequences of nerve damage. It will, however, prevent further damage caused by continued tumor growth. It may also improve certain symptoms caused by nerves that were injured but not permanently damaged.
Radiation Therapy
Stereotactic Radiosurgery (SRS) is a non-invasive alternative to surgery, using very focused radiation therapy. This method targets tumor cells with a focused beam of radiation, killing them while minimizing damage to neighboring healthy cells, such as the cranial nerves or the brain. This treatment is reserved for small- or medium-sized tumors and is administered in a single sitting.
Radiation therapy is most often recommended for patients who cannot tolerate surgery due to age or poor health, or for small tumors. It does not remove the tumor, nor does it address any symptoms caused by the tumor. The goal of radiation therapy is to stop the tumor from growing and causing new symptoms.
Why Choose CNSO?
CNSO is New Jersey’s most comprehensive center for brain tumors and other brain and spine conditions. Treatments are provided by an award-winning team of neurosurgeons, physiatrists, rehabilitation specialists, and other professionals who have trained at some of the nation’s top institutions and partnered with the region’s top brain tumor hospitals and brain tumor centers.
The CNSO care team employs a conservative philosophy toward treatment. Every patient evaluation involves the consideration of whether an evidence-based, non-invasive technique would ultimately be the best treatment for the patient. Surgical solutions are recommended only when necessary and are planned carefully to ensure the best possible outcomes from every operation.
Find Expert Vestibular Schwannoma Treatment Near You in New Jersey
A vestibular schwannoma diagnosis can seriously impact a person’s life. Patients with symptoms of a vestibular schwannoma can find comprehensive care at Centers for Neurosurgery, Spine & Orthopedics. The award-winning CNSO specialists provide care at convenient locations near you across Bergen, Passaic, Essex, Morris, Union, Middlesex, Monmouth, and Hudson counties in New Jersey. To learn more, contact CNSO today.
FAQ About Vestibular Schwannoma
What is a vestibular schwannoma?
Vestibular schwannoma is a type of benign, slow-growing tumor that forms from Schwann cells, which sheath nerves in the inner ear.
When is observation recommended for a vestibular schwannoma?
Observation is recommended for vestibular schwannomas that are small and cause few to no symptoms, especially when other treatments are deemed risky.
What are the surgical options for vestibular schwannoma?
Surgical approaches for vestibular schwannoma include:
- Middle fossa, or above the ear
- Suboccipital, or behind the ear
- Translabyrinthine, or by removing the inner ear structure
Is radiation therapy effective against vestibular schwannoma?
Radiation therapy is effective at preventing tumor growth, but it cannot eliminate existing symptoms of vestibular schwannoma.
Can a vestibular schwannoma return after treatment?
Rarely, a vestibular schwannoma may return after treatment.
How to decide on the best treatment for a vestibular schwannoma?
The best treatment for vestibular schwannoma depends on the tumor’s size, its location, and what symptoms it causes, in addition to the patient’s overall health.
