Vestibular schwannoma is a type of benign tumor that forms in the ear nerves. Most schwannomas are benign, meaning they grow slowly and are non-cancerous. However, this does not mean they are not dangerous. Vestibular schwannoma can create serious health concerns if they are not treated appropriately by a knowledgeable neurosurgeon.

Centers for Neurosurgery, Spine & Orthopedics (CNSO) features a team of specialists in northern New Jersey offering vestibular schwannoma surgery and other treatments. CNSO provides comprehensive care, staying with patients at every stage, from diagnosis to surgery and rehabilitation. Under CNSO’s expertise, patients can address their vestibular schwannoma for a successful recovery. In many cases, surgery is recommended.

What Is Vestibular Schwannoma?

A vestibular schwannoma is a benign tumor that forms in nerves in the inner ear. The human nervous system contains two main types of cells. Neurons are responsible for transmitting electrical signals throughout the body. These signals contain information about senses and movement. Surrounding the neurons are glial cells, which provide support to the neurons. Schwann cells are a particular type of glial cell. These create sheaths of myelin, a fatty substance that insulates neurons to allow for faster and more accurate signal transmission.

Nerve schwannoma is a type of tumor that forms in Schwann cells. A schwannoma is called “vestibular” when it forms in the inner ear, or vestibule. This tumor type is also sometimes called an acoustic neuroma, and it typically only forms on one side of the head. Very rarely, vestibular schwannomas may grow on both sides.

Schwannomas are known as benign tumors. This means they grow relatively slowly and have a low chance of spreading to nearby cells. Benign tumors can still cause harm, however. The location of vestibular schwannomas places them close to the nerves responsible for hearing and balance. They put these nerves under compression as they grow, impacting their function. Very large vestibular schwannomas may also put pressure on the brain.

Vestibular Schwannoma Signs and Symptoms

Symptoms of vestibular schwannomas appear slowly. In the early stages, the tumor is still tiny, and the nerve compression it creates is negligible. The patient may not notice anything is wrong until the tumor grows large enough to significantly impede nerve function. This growth may take years to develop. When signs finally surface, they are typically related to hearing and balance. Only well-developed tumors will cause symptoms affecting other areas of the body. Symptoms of vestibular schwannoma include:

• Hearing loss: The most common symptom of vestibular schwannoma is a gradual loss of hearing on one side of the head. This may take place over months or years.
• Ear fullness: Patients experiencing hearing loss may also feel a sensation of pressure or fullness in the ear, as if it is clogged or full of water.
• Ear ringing: Another common symptom is tinnitus or a sound in the ear with no clear source. This may sound like constant or sporadic ringing, hissing, buzzing, or roaring.
• Vertigo: The nerves in the ear also control a person’s sense of balance. When they are damaged, the person may feel vertigo, dizziness, or unsteadiness.
• Difficulty walking: The impact on balance makes it difficult for the patient to walk around. They may fall frequently or need constant support to stay on their feet.
• Facial numbness: As the tumor gets larger, it puts pressure against the trigeminal nerve. This creates numbness or a tingling sensation on one side of the face.
• Facial tics: Pressure on the facial nerve also impedes motor control, resulting in uncontrolled twitching, tics, or spasms in the eye, eyebrow, forehead, or mouth.
• Difficulty swallowing: Patients with large tumors may have difficulty swallowing due to changes in sensation or motor control in the tongue or vocal cords.
• Changes in taste: Rarely, vestibular schwannoma can impact the patient’s sense of taste. Food may seem flavorless or taste different.
• Changes in tear production: Also rarely, tear production may be affected. This can create persistent dry eye or unexpected, excessive tear production.
• Headaches: Very large vestibular schwannomas create pressure against the inside of the skull. This creates a dull headache on one side of the head.

Many of these symptoms can be caused by conditions other than a schwannoma. If a person is experiencing any of the above symptoms or any symptom that may be caused by a neurological condition, they should seek a diagnosis and treatment from an appropriate specialist.

Causes and Risk Factors for Vestibular Schwannoma

Vestibular schwannomas, like all tumors, are the result of a sudden change in cell DNA. Cell DNA is its reproductive code, a set of instructions that tells the cell how to replicate. Normally, cells duplicate themselves perfectly to replace those that die off. When the DNA changes, however, the cells begin to replicate incorrectly. New cells are created too quickly, and they do not fulfill their original function. This creates an expanding mass of abnormal tissue.

Vestibular schwannomas are uncommon and can occur at any age. However, they most frequently occur between ages 65 and 74.

In most cases, scientists are unsure why genetic changes occur to create tumors. In some cases, however, vestibular schwannoma can be linked to a disorder called neurofibromatosis type 2. This is an inherited mutation that affects genes responsible for Schwann cell production. This creates a higher likelihood of tumors. Patients with neurofibromatosis type 2 may have bilateral vestibular schwannoma, which develops in both ears. They may also develop schwannoma-like tumors elsewhere in the body.

How Is Vestibular Schwannoma Diagnosed?

When a patient complains of symptoms that may be related to a neurological condition, they will be referred to CNSO for a specialist diagnosis. The CNSO team includes board-certified neurosurgeons who are knowledgeable in tumor diagnosis. They perform a series of tests to confirm that the symptoms are caused by a tumor, pinpoint its location, and evaluate its size and growth. These include:

• Audiometry: Also known as a hearing test, audiometry is designed to test a patient’s hearing. The doctor directs sound into one ear at a time, using a range of volumes and tones. The patient is asked to indicate each time they hear a sound. This test helps the neurosurgeon get a better picture of how a patient’s hearing is affected.
• Neurological exam: This is a type of physical exam that checks for signs of neurological damage. The patient is asked to perform tasks that evaluate hearing, balance, strength, and coordination. The results help doctors determine what parts of the brain are affected by a tumor.
• Imaging tests: If a tumor is suspected, CNSO neurosurgeons may request imaging tests to determine its size and location. X-rays are commonly used, often with a contrast dye, to improve image quality. CNSO also uses computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) scans.

Vestibular Schwannoma Surgery at CNSO

For many patients, the recommended treatment is surgery. This approach is effective in eliminating most schwannomas. The goal of vestibular schwannoma surgery is to remove as much of the tumor as possible, relieving pressure on the nerves while forestalling future growth. The surgeon may employ one of three approaches:

• Middle fossa: This approach is used for patients with small tumors and not much hearing loss. The surgeon makes an incision above the ear and removes some bone to access the tumor without damaging the ear’s internal structure.
• Suboccipital (retrosigmoid): This approach is used for patients with any size tumor and not much hearing loss. The surgeon makes an incision behind the ear and removes some bone. This provides better access to larger tumors but preserves the ear structure.
• Translabyrinthine: This approach is used for patients who have already lost their hearing. The surgeon makes an incision behind the ear and removes part of its inner structure. This gives excellent access to large tumors but renders the ear nonfunctional.

Recovery depends on the chosen approach. Middle fossa and suboccipital surgeries have a chance of preserving the patient’s remaining hearing, while translabyrinthine surgeries leave the ear permanently deaf. None of these approaches can restore hearing that has already been lost. All three, however, can provide relief for other symptoms like balance problems or facial numbness.

Other Treatments for Vestibular Schwannoma

While surgery is effective for many patients, it is not always the recommended approach. CNSO takes a conservative approach to care. Doctors always consider whether a minimally invasive treatment will be effective in addressing the patient’s symptoms. Vestibular schwannomas grow slowly, so nonsurgical treatments are often possible. Some preferred methods include:

Radiation Therapy

Radiation therapy is a non-invasive approach to treating vestibular schwannoma directly. The surgeon directs the patient to lie down on a table and then uses an X-ray or photon beam to deliver a precise beam of radiation. Advanced machinery targets the tumor while minimizing damage to healthy tissue.

The goal of radiation treatment is to kill tumor cells, preventing them from replicating. This should slow or stop tumor growth. Radiation therapy cannot remove the tumor or relieve the patient’s existing symptoms. Therefore, it is best for small tumors without major symptoms.

Monitoring

Direct intervention is not always necessary for vestibular schwannoma. If the tumor is still very small, neurosurgeons may simply choose to monitor it. Regular checkups and imaging scans allow the CNSO team to keep an eye on the tumor and make sure it does not cause further damage.

This approach is most often used for small tumors that do not cause major symptoms. It may also be recommended for older patients or those with serious medical problems, for whom surgery or radiation therapy may be too risky. Direct treatment may still be considered if the tumor continues to grow.

Treat Vestibular Schwannoma at CNSO

When pursuing vestibular schwannoma treatment, it is important that patients go to the right specialist. Centers for Neurosurgery, Spine & Orthopedics employs an all-inclusive team of leading board-certified neurosurgeons, orthopedic spine surgeons, interventional pain management physicians, physiatrists, rehabilitation specialists, and certified physical therapists to give patients the best possible quality of care.

This leading team delivers comprehensive, coordinated care at every stage of the patient journey. CNSO offers convenient locations across northern New Jersey, including Bergen, Passaic, Essex, Morris, and Hudson counties. To learn more about tumor care and surgery, contact CNSO today.

Frequently Asked Questions About Vestibular Schwannoma Surgery

What is vestibular schwannoma?

Vestibular schwannoma is also called acoustic neuroma. It is a type of slow-growing benign tumor that forms in Schwann cells, which provide support to the nervous system.

What causes vestibular schwannoma?

Like other tumors, vestibular schwannomas occur when a change in DNA causes cells to multiply rapidly. Doctors are not certain what causes this change. In some cases, vestibular schwannoma is caused by a genetic disorder called neurofibromatosis type 2, which creates mutations in Schwann cells.

Who is most at risk of vestibular schwannoma?

Vestibular schwannomas can develop in any person at any age. They are very rare and most common between ages 65 and 74.

What are the symptoms of vestibular schwannoma?

Symptoms of vestibular schwannoma often develop slowly. They are caused by the growing tumor creating pressure against nerves in the inner ear and sometimes against the brain and skull if the tumor grows large enough. Common symptoms include:

• Hearing loss on one side of the head
• A high-pitched ringing, buzzing, humming, or roaring sound in one ear
• A sensation of fullness in one ear
• Persistent vertigo
• Loss of balance or difficulty walking
• Dizziness
• Numbness on one side of the face
• Twitching or spasms in the eye, eyebrow, forehead, or mouth
• Difficulty swallowing
• Rarely, changes in taste
• Rarely, dry eyes or excess tears

Is surgery always the treatment for vestibular schwannoma?

Treatment for vestibular schwannoma depends on its size. Small tumors do not always require immediate intervention and may simply be monitored. If the tumor requires treatment, radiation therapy is a preferred non-invasive treatment. Surgery is used when it is necessary to completely remove the tumor. While surgery cannot restore lost hearing, it may provide relief for other symptoms.