Vestibular Schwannoma

A vestibular schwannoma is a benign tumor that begins in Schwann cells on the vestibulocochlear nerve. This nerve starts in the inner ear and carries sound and balance information to the brainstem. A vestibular schwannoma is classified as a type of primary brain tumor that typically grows slowly and does not spread to surrounding tissue. Because of where it forms, the tumor can interfere with hearing and balance and, when larger, may press on nearby facial nerves or brain tissue.

People may also see this condition called acoustic neuroma.

Vestibular schwannoma is often described by whether it affects one side or both sides:

• Unilateral vestibular schwannoma is the most common form and develops on one vestibulocochlear nerve.
• Bilateral vestibular schwannomas are much less common and may suggest an inherited condition such as neurofibromatosis type 2, which requires specialized evaluation and long-term monitoring.

Doctors may also describe the tumor by size, location and how much it affects nearby structures. Those details help determine whether watchful monitoring, radiosurgery or skull base surgery is the best next step.

Symptoms often develop gradually, but they can sometimes appear more suddenly. Common symptoms may include:

• Hearing loss in one ear
• Ringing in one ear
• Vertigo or spinning dizziness
• Headaches
• Nausea or vomiting
• Double vision
• Weakness or numbness in the face
• A sense of imbalance

Symptoms may depend on the tumor’s size and where it is pressing. A smaller tumor may mainly affect hearing or cause tinnitus, while a larger one can affect balance, facial movement or other nearby structures.

Vestibular schwannoma develops when Schwann cells begin growing abnormally on the vestibulocochlear nerve. Many cases happen without a clearly identifiable cause. In a smaller number of people, bilateral tumors or a strong family history may point to an inherited syndrome such as neurofibromatosis type 2.

Risk evaluation usually focuses on personal and family history, the pattern of hearing loss and whether there are signs of other nerve tumors. Because vestibular schwannoma is part of the broader category of brain tumors, patients may need coordinated review by specialists in neurosurgery, neuro-oncology, neuroradiology and radiation oncology.

Diagnosis usually starts with a review of symptoms, a physical exam and a hearing evaluation. After this initial assessment, an MRI is typically used to confirm the diagnosis. MRI creates detailed images of the brain and tumor and helps your care team understand the tumor’s size, location and relationship to nearby structures.

At Baptist Health Brain & Spine Care, diagnosis may involve diagnostic imaging and radiology, a brain MRI and consultation with specialists who treat brain and spine tumors. Some patients also need follow-up imaging over time to track growth before treatment decisions are made.

Treatment depends on tumor size, location, symptoms, growth rate, hearing status and your overall health. Baptist Health Brain & Spine Care specialists utilize a multidisciplinary approach that uses advanced imaging and personalized planning to improve symptoms while protecting nerve and brain function.

Possible treatment approaches may include:

• Monitoring with repeat imaging and hearing tests when the tumor is small, slow-growing or causing limited symptoms
• Surgery when the tumor’s size, location or symptoms make removal the safest or most effective option. Some patients may be evaluated for skull base surgery.
• Radiation therapy when surgery is not the best option or when tumor remains after surgery. Baptist Health Brain & Spine Care offers intensity modulated radiation therapy, image-guided radiation therapy and stereotactic radiosurgery among the options used for acoustic neuroma.
• Proton therapy for selected patients, as part of Baptist Health Cancer Care's advanced radiation program
• Neurocognitive evaluation before treatment when needed to assess brain function and support treatment planning

Without treatment or monitoring, a vestibular schwannoma can continue to grow and place pressure on nearby nerves and brain structures. This can lead to worsening hearing loss, more severe balance problems, persistent tinnitus, facial numbness or weakness, and in some cases more significant neurologic symptoms.

Complications can also relate to treatment and may include changes in hearing, facial nerve effects, balance issues or the need for long-term imaging follow-up. That is why care planning often includes detailed discussion of the benefits and risks of observation, surgery and radiosurgery.

There is no proven way to prevent most vestibular schwannomas. The best preventive strategy is early evaluation of one-sided hearing loss, tinnitus, dizziness or ongoing balance problems so that diagnosis and treatment planning can happen before symptoms become more severe.

For people with a family history suggestive of neurofibromatosis type 2 or other hereditary tumor syndromes, genetic counseling and specialist follow-up may help identify problems earlier.

If you have symptoms such as hearing loss in one ear, ringing in one ear, vertigo or facial numbness, the next step is a prompt medical evaluation.

To schedule a visit with a Baptist Health Brain & Spine Care provider, fill out an appointment request form or call 833-596-3876.