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Acoustic neuroma

Background knowledge 🧠

Overview

  • Definition: A benign tumour arising from the Schwann cells, most commonly involving the vestibular portion of the vestibulocochlear nerve (cranial nerve VIII).
  • It’s a non-cancerous, slow-growing tumour.

Etiology

  • Idiopathic in most cases.
  • Association with neurofibromatosis type II (NF2) – an autosomal dominant genetic condition.

Classification / types

  • Unilateral: Usually sporadic
  • Bilateral: Often associated with NF2

Pathophysiology

  • Growth of tumour can compress surrounding structures including cranial nerves and brainstem
  • Can lead to hydrocephalus if cerebrospinal fluid flow is blocked

Clinical Features 🌑️

Symptoms

  • Hearing loss
  • Tinnitus
  • Vertigo or imbalance

Signs

  • Unilateral sensorineural hearing loss
  • Ataxia
  • Cranial nerve palsies (rare)

Investigations πŸ§ͺ

Initial tests

  • Audiometry: Assessing the extent of hearing loss.
  • Basic neurological examination

Diagnostic tests

Magnetic Resonance Imaging (MRI): The gold standard for diagnosis, can show the size and location of the tumour.

Management πŸ₯Ό

Initial management

  • Monitoring (watchful waiting)
  • Symptomatic treatment (e.g., for vertigo)

Definitive management

  • Surgical resection
  • Radiosurgery (e.g., Gamma Knife)

Complications

  • Facial nerve damage leading to facial weakness or paralysis.
  • Cerebrospinal fluid leakage.
  • Hearing loss.
  • Meningitis.

Key Points
  • Acoustic neuromas are typically slow-growing tumours that can lead to hearing loss, tinnitus, and balance issues.
  • While benign, they can cause significant morbidity due to their location.
  • Management can range from observation to surgical intervention, depending on the size, location, and symptoms.

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