Abstract
Vestibular schwannomas are the most common cerebellopontine angle tumor. During the past century, the management goals of vestibular schwannomas have shifted from total resection to functional preservation. Current treatment options include surgical resection, stereotactic radiosurgery, and observation. Imaging has become a crucial part of the initial screening, evaluation, and follow-up assessment of vestibular schwannomas. Recognizing and understanding the management objectives, various treatment modalities, expected posttreatment findings, and complications allows the radiologist to play an essential role in a multidisciplinary team by providing key findings relevant to treatment planning and outcome assessment. The authors provide a comprehensive discussion of the surgical management, role of radiation therapy and observation, imaging differential, and pre- and posttreatment imaging findings of vestibular schwannomas.
Highlights
Vestibular schwannomas (VSs), often referred to as “acoustic neuroma,” most commonly originates from the vestibular division of the vestibulocochlear nerve sheath, often at the transition from central to peripheral myelin near the vestibular ganglion at the internal auditory canal (IAC) fundus.Inactivation of the neurofibromin 2 gene has been implicated in sporadic and neurofibromatosis type 2 VS.[11]
Sensorineural hearing loss is confirmed by audiometry and brain stem– evoked response audiometry, with findings that are abnormal in Ͼ90%–95% of patients with VS.[12]
This study reported 100% sensitivity with high specificity and advocated adding a coronal T2WI to reduce false-positive/
Summary
VS, often referred to as “acoustic neuroma,” most commonly originates from the vestibular division of the vestibulocochlear nerve sheath, often at the transition from central to peripheral myelin near the vestibular ganglion at the IAC fundus.Inactivation of the neurofibromin 2 gene has been implicated in sporadic and neurofibromatosis type 2 VS.[11]. Imaging plays a central role in the screening and initial and follow-up assessment of VSs. Imaging can often differentiate VS from other entities such as facial nerve schwannoma, meningioma, epidermoid cyst, arachnoid cyst, aneurysm, and metastasis.[2] MR imaging is the preferred technique and can provide exquisite tumor characterization, surgical planning, and posttherapeutic evaluation.[3,4,5] Contrast-enhanced CT of the temporal bones can serve as an alternative if the patient cannot undergo MR imaging.
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