====== Vestibular schwannoma ======

===== Latest news =====

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===== Definition =====

A [[vestibular]] [[schwannoma]] (also known as [[acoustic neuroma]], [[acoustic neurinoma]], or [[acoustic neurilemoma]]) is a benign, usually slow-growing [[cerebellopontine angle tumor]] that develops from the [[balance]] and [[hearing]] nerves supplying the [[inner ear]]. The tumor comes from an overproduction of [[Schwann cell]]s.

They usually originate in the [[internal acoustic meatus]], and gradually extend into the [[cerebellopontine cistern]]. Invasive growth into the [[petrous bone]] is extremely rare. This may have arisen because of an unusually peripheral site of origin on the [[vestibular nerve]]
((Matsumura H, Matsuda M, Tabuchi K, Yamamoto T, Ishikawa E, Matsumura A.
Vestibular schwannoma extending into the tympanic cavity and jugular fossa by
invasion of the petrous bone. Br J Neurosurg. 2019 Mar 11:1-3. doi:
10.1080/02688697.2019.1588226. [Epub ahead of print] PubMed PMID: 30856348.
)).
----
In the narrow confines of [[neurosurgery]], [[neurology]], and [[neuroradiology]], changes in [[nomenclature]] have been motivated by improved understanding of [[disease]] states reflected in precision of the newly adopted appellation. Numerous examples of novel nomenclature demonstrate the potential benefit, including paradigm shifts in understanding as well as treatments for disease. For example, [[acoustic neuroma]]s no longer exists, replaced with the more accurate [[vestibular schwannoma]]
((Eldridge R, Parry D. Vestibular schwannoma (acoustic
neuroma). Consensus development conference.
Neurosurgery 1992;30:962–4)).

===== Epidemiology =====

see [[Vestibular schwannoma epidemiology]].

===== Etiology =====

see [[Vestibular schwannoma etiology]].

===== Classification =====

see [[Vestibular schwannoma classification]].

===== Natural history =====

see [[Vestibular schwannoma natural history]].

===== Pathology =====

Tumors are composed of Antoni A fibers (narrow elongated bipolar cells) and Antoni B fibers (loose reticulated). Verocay bodies are also seen, and consist of acellular eosinophilic areas surrounded by parallel arrangement of spindle shaped schwann cells (they are not a cell type).

===== Clinical Features =====

see [[Vestibular schwannoma clinical features]].

===== Diagnosis =====

see [[Vestibular schwannoma diagnosis]].

===== Scores =====

see [[Vestibular schwannoma scores]].

===== Differential diagnosis =====

[[Vestibular schwannoma differential diagnosis]] 


===== Guidelines =====

see [[Vestibular schwannoma guidelines]].

===== Treatment =====

see [[Vestibular schwannoma treatment]].


===== Outcome =====
see [[Vestibular schwannoma outcome]].

===== Meta-analysis =====

see [[Vestibular Schwannoma Meta-analysis]]

===== Observational cohort studies =====

One hundred seventy-three patients diagnosed with unilateral [[vestibular schwannoma]] operated via the [[retrosigmoid approach]] were included in a study from the [[People's Liberation Army General Hospital]] [[Beijing]].
All patients underwent relevant [[examination]]s and completed the [[Tinnitus Handicap Inventory]] scale before surgery and 6 months after surgery. The [[prognosis]] of tinnitus was evaluated according to the changes in THI.

Of the 129 preoperative [[tinnitus]] patients, postoperative tinnitus resolved in 12.4%, improved in 29.5%, remained unchanged in 28.6%, and worsened in 29.5%. 18.2% of 44 patients without preoperative tinnitus appeared new-onset tinnitus postoperatively. Thirty-six patients never had tinnitus. Patients with smaller tumor sizes (≤ 3 cm) were more likely to experience preoperative tinnitus. Younger patients and those with [[serviceable hearing]] preoperatively were more likely to report their tinnitus unchanged or worsened. A new onset of postoperative tinnitus in the preoperative non-tinnitus group was found in better preoperative hearing function.

70% of patients had persistent tinnitus after [[vestibular schwannoma]] [[resection]]. The [[tinnitus]] [[prognosis]] was influenced by [[age]] and [[preoperative]] [[hearing]] [[function]]. Tinnitus is a bothersome symptom and is often underestimated by doctors. Assessment of tinnitus is mandatory during the [[vestibular schwannoma management]]
((You N, Zhang J, Zhang D, Zhao Y, Zhang J, Xu B. Predictive factors of tinnitus after vestibular schwannoma surgery: a case-control study. Chin Neurosurg J. 2024 Apr 3;10(1):10. doi: 10.1186/s41016-024-00363-6. PMID: 38566173.))

===== Case series =====

see [[Vestibular schwannoma case series]].

===== Case reports =====

see [[Vestibular schwannoma case reports]].

===== Books =====

[[Vestibular Schwannoma Books]].