Vestibular schwannoma

Vestibular schwannoma

These are nerve sheath tumours arising in the cerebellopontine - angle ( Figure 48.27 ) that present with hearing loss, tinnitus - and balance problems. Facial numbness and weakness are less common, while large tumours may present with features of brainstem compression or hydrocephalus. The di ff erential - diagnosis includes meningioma, metastasis and epidermoid cyst. Small intracanalicular tumours (within the internal audi tory canal) may be managed with surveillance. For intermediate size tumours, radiosurgery is an alternative to operation. Large lesions (>4 /uni00A0 cm), especially with brainstem compression, require excision and consideration of ventriculoperitoneal shunt to relieve hydrocephalus. Translabyrinthine, retrosigmoid and middle fossa approaches are possible, the latter options o ff ering potential preservation of hearing in smaller tumours with some intact function at presentation. Patients with larger tumours will typically have no serviceable hearing in the a ff ected ear and the focus is then on preserving facial nerve function. Summary box 48.11 Skull base and paediatric tumours /uni25CF /uni25CF Paediatric neurosurgery incorporates the management of tumours and developmental abnormalities, for example cysts, neural tube defects and posterior fossa malformations. In general these present with combinations of developmental delay , seizures and macrocephaly or hydrocephalus. Early fusion of one or more cranial sutures, craniosynostosis, is also a common neonatal presentation.

Figure 48.27 The appearances of a meningioma in the left cere bellopontine angle (CPA) (long arrow), with a coexisting vestibular schwannoma in the right CPA (short arrow). Pituitary tumours typically present with endocrinological disturbance (microadenomas) or visual de /f_i cits due to compression (macroadenomas). Some of these tumours are managed surgically, in close cooperation with endocrinologists Vestibular schwannomas (acoustic neuromas) are benign nerve sheath tumours, usually presenting with hearing loss, tinnitus and balance problems. Their proximity to the brainstem allows them to cause signi /f_i cant morbidity and mortality and can present a major surgical challenge

Vestibular schwannoma

These are nerve sheath tumours arising in the cerebellopontine - angle ( Figure 48.27 ) that present with hearing loss, tinnitus - and balance problems. Facial numbness and weakness are less common, while large tumours may present with features of brainstem compression or hydrocephalus. The di ff erential - diagnosis includes meningioma, metastasis and epidermoid cyst. Small intracanalicular tumours (within the internal audi tory canal) may be managed with surveillance. For intermediate size tumours, radiosurgery is an alternative to operation. Large lesions (>4 /uni00A0 cm), especially with brainstem compression, require excision and consideration of ventriculoperitoneal shunt to relieve hydrocephalus. Translabyrinthine, retrosigmoid and middle fossa approaches are possible, the latter options o ff ering potential preservation of hearing in smaller tumours with some intact function at presentation. Patients with larger tumours will typically have no serviceable hearing in the a ff ected ear and the focus is then on preserving facial nerve function. Summary box 48.11 Skull base and paediatric tumours /uni25CF /uni25CF Paediatric neurosurgery incorporates the management of tumours and developmental abnormalities, for example cysts, neural tube defects and posterior fossa malformations. In general these present with combinations of developmental delay , seizures and macrocephaly or hydrocephalus. Early fusion of one or more cranial sutures, craniosynostosis, is also a common neonatal presentation.

Figure 48.27 The appearances of a meningioma in the left cere bellopontine angle (CPA) (long arrow), with a coexisting vestibular schwannoma in the right CPA (short arrow). Pituitary tumours typically present with endocrinological disturbance (microadenomas) or visual de /f_i cits due to compression (macroadenomas). Some of these tumours are managed surgically, in close cooperation with endocrinologists Vestibular schwannomas (acoustic neuromas) are benign nerve sheath tumours, usually presenting with hearing loss, tinnitus and balance problems. Their proximity to the brainstem allows them to cause signi /f_i cant morbidity and mortality and can present a major surgical challenge

Vestibular schwannoma

These are nerve sheath tumours arising in the cerebellopontine - angle ( Figure 48.27 ) that present with hearing loss, tinnitus - and balance problems. Facial numbness and weakness are less common, while large tumours may present with features of brainstem compression or hydrocephalus. The di ff erential - diagnosis includes meningioma, metastasis and epidermoid cyst. Small intracanalicular tumours (within the internal audi tory canal) may be managed with surveillance. For intermediate size tumours, radiosurgery is an alternative to operation. Large lesions (>4 /uni00A0 cm), especially with brainstem compression, require excision and consideration of ventriculoperitoneal shunt to relieve hydrocephalus. Translabyrinthine, retrosigmoid and middle fossa approaches are possible, the latter options o ff ering potential preservation of hearing in smaller tumours with some intact function at presentation. Patients with larger tumours will typically have no serviceable hearing in the a ff ected ear and the focus is then on preserving facial nerve function. Summary box 48.11 Skull base and paediatric tumours /uni25CF /uni25CF Paediatric neurosurgery incorporates the management of tumours and developmental abnormalities, for example cysts, neural tube defects and posterior fossa malformations. In general these present with combinations of developmental delay , seizures and macrocephaly or hydrocephalus. Early fusion of one or more cranial sutures, craniosynostosis, is also a common neonatal presentation.

Figure 48.27 The appearances of a meningioma in the left cere bellopontine angle (CPA) (long arrow), with a coexisting vestibular schwannoma in the right CPA (short arrow). Pituitary tumours typically present with endocrinological disturbance (microadenomas) or visual de /f_i cits due to compression (macroadenomas). Some of these tumours are managed surgically, in close cooperation with endocrinologists Vestibular schwannomas (acoustic neuromas) are benign nerve sheath tumours, usually presenting with hearing loss, tinnitus and balance problems. Their proximity to the brainstem allows them to cause signi /f_i cant morbidity and mortality and can present a major surgical challenge