Acoustic Neuroma

Question 1

Define acoustic neuroma

Answer 1

Histologically benign, generally slow growing tumour that may remain stable for long periods on follo-wup MRI scans after initial detection

Question 2

Aetiology and risk factors of acoustic neuroma

Answer 2

Benign, slow-growing tumour of superior vestibular nerve → acts as a SOL and so causes a cerebellopontine angle syndrome (CPA syndrome)
Associated with neurofibromatosis 2 (bilateral VS)

RF:
Exposure to ionising radiation
Neurofibromatosis

Question 3

Symptoms of acoustic neuroma

Answer 3

Hearing loss: Slow onset, UNILATERAL
Tinnitus
Vertigo
Headache

Question 4

Signs of acoustic neuroma on examination

Answer 4

Unilateral hearing loss
CN palsy (5, 7, 8)
Cerebellar signs: DANISH

Question 5

Investigations for acoustic neuroma

Answer 5

MRI (gold standard): mass within the internal auditory canal ± extention into the cerebellopontine angle
Pure tone audiometry: sensorineural/retrocochlear hearing loss

Question 6

Management for acoustic neuroma

Answer 6

Urgent ENT referral
- Observation
- Gamma knife surgery
- Radiotherapy

Question 7

Complications of treatment for acoustic neuroma

Answer 7

Surgery
- Hearing loss
- Facial weakness
- Facial numbness
- CSF leak
Radiation
- Secondary malignancy
- Hydrocephalus
- Hearing loss
- Facial nerve palsy

Question 8

Prognosis for acoustic neuroma

Answer 8

Many patients have no intervention due to the slow-growing nature
Patients live undisturbed by their tumours
Treatment holds very good prognosis with minimal complications

Question 9

Differentials for acoustic neuroma

Answer 9

Meningioma
Cerebellar astrocytoma
Mets