Education and debate

Fortnightly Review: Management of acoustic neuroma

BMJ 1995; 311 doi: 10.1136/bmj.311.7013.1141 (Published 28 October 1995)
Cite this as: BMJ 1995;311:1141

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  1. A Wright, professor of otolaryngologya,
  2. R Bradford, consultant neurosurgeona
  1. aRoyal National Throat, Nose and Ear Hospital, London WC1X 8EE
  2. bRoyal Free Hospital Medical School, London NW3 2QG
  1. Correspondence to: Professor Wright.

    Summary points

    • The onset of unilateral auditory symptoms requires investigation

    • A unilateral sensorineural loss or tinnitus when the eardrum is normal also needs further investigation

    • The definitive investigation is gadolinium enhanced magnetic resonance scanning

    • Neurological symptoms suggestive of compression of the lower cranial nerves,ataxia, or raised intracranial pressure may be caused by benign tumours in the cerebellopontine angle

    • Treatments include expectant care with repeat scanning to assess tumour growth in elderly people, and surgery with or without stereotactic radiotherapy

    • The smaller the tumour the lower the risks of treatment

    The past 10 years have seen remarkable advances in the diagnosis and management of tumours that grow in the narrow space between the brain stem and cerebellum and the inside surface of the temporal bone--the so called cerebellopontine angle. The tumours that grow here are not uncommon, and the published annual incidence of symptomatic acoustic neuromas diagnosed during life is usually taken as around 1 per 100 000.1 This figure accounts for the vast majority of all the different types of tumour found in this region. Most of these tumours are benign, but are located in a surgically awkward spot with important neurological structures close by.

    Nowadays there is probably no good excuse to miss the early diagnosis of tumours in this region, and this is important since if treatment by surgery or radiotherapy is contemplated then the smaller the tumour the better the results.2

    Contents of the cerebellopontine angle

    Running across the cerebellopontine angle from the brain stem are the facial (VII) and acoustic and vestibular (VIII) nerves on their way to the internal auditory meatus and thence to the muscles of facial expression and the cochlear and vestibular labyrinths respectively. At the apex of the cerebellopontine is the trigeminal (V) nerve carrying sensation from the face and supplying the muscles of mastication. At the …

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