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Otolaryngology (ENT)1845 papers

Schwannoma

Last edited: 4/14/2026

Overview

Vestibular schwannoma (VS) is the most common cerebellopontine angle tumor, typically benign but requiring tailored management based on tumor characteristics, symptoms, and patient factors 1.

Diagnosis

  • Key Diagnostic Criteria: Asymmetrical sensorineural hearing loss, tinnitus, vertigo, and cranial nerve deficits 7.
  • Recommended Tests: Magnetic resonance imaging (MRI) is essential for diagnosis and assessing tumor size and extension 7.
  • Grading: Utilize the Chang classification or other tumor size and growth criteria to guide management decisions 6.

    • Management

  • First-Line Treatments:
    • - Observation: For small, asymptomatic tumors 1. - Surgical Resection: Translabyrinthine, middle fossa, or extended approaches depending on tumor size and location 123. - Radiosurgery: Gamma knife or stereotactic radiotherapy for selected cases 1.
  • Adjunctive Treatments:
    • - Postoperative Imaging Surveillance: MRI at variable intervals post-resection to monitor recurrence or growth 517. - Facial Nerve Monitoring: Intraoperative electrophysiological monitoring to assess facial nerve function 18.

    Special Populations

  • Pregnancy: Management strategies may need to be adapted due to physiological changes and potential risks to the fetus 21.
  • Elderly: Consider comorbidities and functional status when choosing between observation, surgery, or radiosurgery 11.

    • Key Recommendations

  • Tailor Management Based on Tumor Characteristics and Patient Symptoms: Use MRI to guide treatment decisions, favoring observation for small, asymptomatic tumors 1 (Evidence: Strong).
  • Incorporate Intraoperative Monitoring for Facial Nerve Preservation: Utilize electrophysiological techniques to assess and protect facial nerve function during surgery 18 (Evidence: Moderate).
  • Establish Postoperative Surveillance Protocols: Implement regular MRI follow-up to monitor tumor behavior post-resection, though specific intervals may vary 517 (Evidence: Moderate).

    • References

    1 Lassaletta L, Acle Cervera L, Altuna X, Amilibia Cabeza E, Arístegui Ruiz M, Batuecas Caletrio Á et al.. Clinical practice guideline on the management of vestibular schwannoma. Acta otorrinolaringologica espanola 2024. link 2 Silva VAR, Lavinsky J, Pauna HF, Vianna MF, Santos VM, Ikino CMY et al.. Brazilian Society of Otology task force - Vestibular Schwannoma ‒ evaluation and treatment. Brazilian journal of otorhinolaryngology 2023. link 3 Goldbrunner R, Weller M, Regis J, Lund-Johansen M, Stavrinou P, Reuss D et al.. EANO guideline on the diagnosis and treatment of vestibular schwannoma. Neuro-oncology 2020. link 4 Barber SR, Jain S, Mooney MA, Almefty KK, Lawton MT, Son YJ et al.. Combining Stereoscopic Video and Virtual Reality Simulation to Maximize Education in Lateral Skull Base Surgery. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2020. link 5 Bukoski RS, Appelbaum EN, Coelho DH. Postoperative MRI Surveillance of Vestibular Schwannomas: Is There a Standard of Care?. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 2020. link 6 Kania R, Vérillaud B, Camous D, Hautefort C, Somers T, Waterval J et al.. EAONO position statement on Vestibular Schwannoma: Imaging Assessment Question: How should growth of Vestibular Schwannoma be defined?. The journal of international advanced otology 2018. link 7 Waterval J, Kania R, Somers T. EAONO Position Statement on Vestibular Schwannoma: Imaging Assessment. What are the Indications for Performing a Screening MRI Scan for a Potential Vestibular Schwannoma?. The journal of international advanced otology 2018. link 8 Hu J, Liu X, Ge N, Wang S, Guo J, Wang G et al.. Role of endoscopic ultrasound and endoscopic resection for the treatment of gastric schwannoma. Medicine 2017. link 9 Gueldich M, Hentati A, Chakroun A, Abid H, Kammoun S, M'saad S et al.. Giant cystic schwannoma of the middle mediastinum with cervical extension. The Libyan journal of medicine 2015. link 10 Youn B, Lee SH, Kim ES, Eoh W. Intraosseous schwannoma with ancient change on the lumbar spine. British journal of neurosurgery 2012. link 11 Ward BK, Gourin CG, Francis HW. Vestibular schwannoma surgical volume and short-term outcomes in Maryland. Archives of otolaryngology--head & neck surgery 2012. link 12 Monfared A, Mudry A, Jackler R. The history of middle cranial fossa approach to the cerebellopontine angle. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 2010. link 13 Tan M, Myrie OA, Lin FR, Niparko JK, Minor LB, Tamargo RJ et al.. Trends in the management of vestibular schwannomas at Johns Hopkins 1997-2007. The Laryngoscope 2010. link 14 Muramatsu K, Ihara K, Kato Y, Yoshida Y, Taguchi T. Intrasacral schwannoma: clinical presentation, diagnosis and management. British journal of neurosurgery 2008. link 15 Garza I. Craniocervical junction schwannoma mimicking occipital neuralgia. Headache 2007. link 16 Sharp MC, MacfArlane R, Hardy DG, Jones SE, Baguley DM, Moffat DA. Team working to improve outcome in vestibular schwannoma surgery. British journal of neurosurgery 2005. link 17 Lee WJ, Isaacson JE. Postoperative imaging and follow-up of vestibular schwannomas. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 2005. link 18 Axon PR, Ramsden RT. Assessment of real-time clinical facial function during vestibular schwannoma resection. The Laryngoscope 2000. link 19 Welling DB, Slater PW, Thomas RD, McGregor JM, Goodman JE. The learning curve in vestibular schwannoma surgery. The American journal of otology 1999. link 20 Murakami N, Tanaka T, Ohmori Y, Shirouzu Y, Ishibashi S, Harada Y et al.. A case report of rectal schwannoma. The Kurume medical journal 1996. link 21 Moffat DA, Hardy DG, Irving RM, Viani L, Beynon GJ, Baguley DM. Referral patterns in vestibular schwannomas. Clinical otolaryngology and allied sciences 1995. link 22 Deogaonkar M, Goel A, Nagpal RD, Desai AP. Intraparenchymal schwannoma of the frontal lobe. Journal of postgraduate medicine 1994. link 23 Naguib MB, Saleh E, Cokkeser Y, Aristegui M, Landolfi M, Taibah AK et al.. The enlarged translabyrinthine approach for removal of large vestibular schwannomas. The Journal of laryngology and otology 1994. link 24 Wood MK, Erdmann MW, Davies DM. Malignant schwannoma mistakenly diagnosed as carpal tunnel syndrome. Journal of hand surgery (Edinburgh, Scotland) 1993. link90104-n) 25 Andrew SM, Freemont AJ. Juxtacortical malignant schwannoma with heterologous elements. Histopathology 1993. link 26 Feghali JG, Kantrowitz AB. Transcranial translabyrinthine approach to vestibular schwannomas. The Journal of laryngology and otology 1993. link 27 Kostakopoulos A, Pikramenos D, Livadas K, Antonopoulos P, Demonakou M. Malignant schwannoma of the adrenals. A rare case. Acta urologica Belgica 1991. link 28 Sarkar C, Mehta VS, Roy S. Intracerebellar schwannoma. Case report. Journal of neurosurgery 1987. link 29 Miettinen M. Melanotic schwannoma coexpression of vimentin and glial fibrillary acidic protein. Ultrastructural pathology 1987. link 30 Bursztyn EM, Prada A. Intradural cauda equina schwannoma. Surgical neurology 1986. link90341-1) 31 Lodding P, Kindblom LG, Angervall L. Epithelioid malignant schwannoma. A study of 14 cases. Virchows Archiv. A, Pathological anatomy and histopathology 1986. link 32 Matsunou H, Shimoda T, Kakimoto S, Yamashita H, Ishikawa E, Mukai M. Histopathologic and immunohistochemical study of malignant tumors of peripheral nerve sheath (malignant schwannoma). Cancer 1985. link56:9<2269::aid-cncr2820560922>3.0.co;2-#) 33 Brooks JS, Freeman M, Enterline HT. Malignant "Triton" tumors. Natural history and immunohistochemistry of nine new cases with literature review. Cancer 1985. link55:11<2543::aid-cncr2820551105>3.0.co;2-4) 34 Lesoin F, Krivosic I, Cama A, Jomin M. A giant intrasacral schwannoma revealed by lumbosacral pain. Neurochirurgia 1984. link 35 Di Gregorio C, Fano RA, Criscuolo M. Melanotic schwannoma: a case report. Applied pathology 1984. link

    Original source

    1. [1]
      Clinical practice guideline on the management of vestibular schwannoma. — Lassaletta L, Acle Cervera L, Altuna X, Amilibia Cabeza E, Arístegui Ruiz M, Batuecas Caletrio Á et al. Acta otorrinolaringologica espanola (2024)
    2. [2]
      Brazilian Society of Otology task force - Vestibular Schwannoma ‒ evaluation and treatment. — Silva VAR, Lavinsky J, Pauna HF, Vianna MF, Santos VM, Ikino CMY et al. Brazilian journal of otorhinolaryngology (2023)
    3. [3]
      EANO guideline on the diagnosis and treatment of vestibular schwannoma. — Goldbrunner R, Weller M, Regis J, Lund-Johansen M, Stavrinou P, Reuss D et al. Neuro-oncology (2020)
    4. [4]
      Combining Stereoscopic Video and Virtual Reality Simulation to Maximize Education in Lateral Skull Base Surgery. — Barber SR, Jain S, Mooney MA, Almefty KK, Lawton MT, Son YJ et al. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2020)
    5. [5]
      Postoperative MRI Surveillance of Vestibular Schwannomas: Is There a Standard of Care? — Bukoski RS, Appelbaum EN, Coelho DH Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology (2020)
    6. [6]
      EAONO position statement on Vestibular Schwannoma: Imaging Assessment Question: How should growth of Vestibular Schwannoma be defined? — Kania R, Vérillaud B, Camous D, Hautefort C, Somers T, Waterval J et al. The journal of international advanced otology (2018)
    7. [7]
      EAONO Position Statement on Vestibular Schwannoma: Imaging Assessment. What are the Indications for Performing a Screening MRI Scan for a Potential Vestibular Schwannoma? — Waterval J, Kania R, Somers T The journal of international advanced otology (2018)
    8. [8]
      Role of endoscopic ultrasound and endoscopic resection for the treatment of gastric schwannoma. — Hu J, Liu X, Ge N, Wang S, Guo J, Wang G et al. Medicine (2017)
    9. [9]
      Giant cystic schwannoma of the middle mediastinum with cervical extension. — Gueldich M, Hentati A, Chakroun A, Abid H, Kammoun S, M'saad S et al. The Libyan journal of medicine (2015)
    10. [10]
      Intraosseous schwannoma with ancient change on the lumbar spine. — Youn B, Lee SH, Kim ES, Eoh W British journal of neurosurgery (2012)
    11. [11]
      Vestibular schwannoma surgical volume and short-term outcomes in Maryland. — Ward BK, Gourin CG, Francis HW Archives of otolaryngology--head & neck surgery (2012)
    12. [12]
      The history of middle cranial fossa approach to the cerebellopontine angle. — Monfared A, Mudry A, Jackler R Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology (2010)
    13. [13]
      Trends in the management of vestibular schwannomas at Johns Hopkins 1997-2007. — Tan M, Myrie OA, Lin FR, Niparko JK, Minor LB, Tamargo RJ et al. The Laryngoscope (2010)
    14. [14]
      Intrasacral schwannoma: clinical presentation, diagnosis and management. — Muramatsu K, Ihara K, Kato Y, Yoshida Y, Taguchi T British journal of neurosurgery (2008)
    15. [15]
      Craniocervical junction schwannoma mimicking occipital neuralgia. — Garza I Headache (2007)
    16. [16]
      Team working to improve outcome in vestibular schwannoma surgery. — Sharp MC, MacfArlane R, Hardy DG, Jones SE, Baguley DM, Moffat DA British journal of neurosurgery (2005)
    17. [17]
      Postoperative imaging and follow-up of vestibular schwannomas. — Lee WJ, Isaacson JE Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology (2005)
    18. [18]
      Assessment of real-time clinical facial function during vestibular schwannoma resection. — Axon PR, Ramsden RT The Laryngoscope (2000)
    19. [19]
      The learning curve in vestibular schwannoma surgery. — Welling DB, Slater PW, Thomas RD, McGregor JM, Goodman JE The American journal of otology (1999)
    20. [20]
      A case report of rectal schwannoma. — Murakami N, Tanaka T, Ohmori Y, Shirouzu Y, Ishibashi S, Harada Y et al. The Kurume medical journal (1996)
    21. [21]
      Referral patterns in vestibular schwannomas. — Moffat DA, Hardy DG, Irving RM, Viani L, Beynon GJ, Baguley DM Clinical otolaryngology and allied sciences (1995)
    22. [22]
      Intraparenchymal schwannoma of the frontal lobe. — Deogaonkar M, Goel A, Nagpal RD, Desai AP Journal of postgraduate medicine (1994)
    23. [23]
      The enlarged translabyrinthine approach for removal of large vestibular schwannomas. — Naguib MB, Saleh E, Cokkeser Y, Aristegui M, Landolfi M, Taibah AK et al. The Journal of laryngology and otology (1994)
    24. [24]
      Malignant schwannoma mistakenly diagnosed as carpal tunnel syndrome. — Wood MK, Erdmann MW, Davies DM Journal of hand surgery (Edinburgh, Scotland) (1993)
    25. [25]
      Juxtacortical malignant schwannoma with heterologous elements. — Andrew SM, Freemont AJ Histopathology (1993)
    26. [26]
      Transcranial translabyrinthine approach to vestibular schwannomas. — Feghali JG, Kantrowitz AB The Journal of laryngology and otology (1993)
    27. [27]
      Malignant schwannoma of the adrenals. A rare case. — Kostakopoulos A, Pikramenos D, Livadas K, Antonopoulos P, Demonakou M Acta urologica Belgica (1991)
    28. [28]
      Intracerebellar schwannoma. Case report. — Sarkar C, Mehta VS, Roy S Journal of neurosurgery (1987)
    29. [29]
      Melanotic schwannoma coexpression of vimentin and glial fibrillary acidic protein. — Miettinen M Ultrastructural pathology (1987)
    30. [30]
      Intradural cauda equina schwannoma. — Bursztyn EM, Prada A Surgical neurology (1986)
    31. [31]
      Epithelioid malignant schwannoma. A study of 14 cases. — Lodding P, Kindblom LG, Angervall L Virchows Archiv. A, Pathological anatomy and histopathology (1986)
    32. [32]
      Histopathologic and immunohistochemical study of malignant tumors of peripheral nerve sheath (malignant schwannoma). — Matsunou H, Shimoda T, Kakimoto S, Yamashita H, Ishikawa E, Mukai M Cancer (1985)
    33. [33]
      Malignant "Triton" tumors. Natural history and immunohistochemistry of nine new cases with literature review. — Brooks JS, Freeman M, Enterline HT Cancer (1985)
    34. [34]
      A giant intrasacral schwannoma revealed by lumbosacral pain. — Lesoin F, Krivosic I, Cama A, Jomin M Neurochirurgia (1984)
    35. [35]
      Melanotic schwannoma: a case report. — Di Gregorio C, Fano RA, Criscuolo M Applied pathology (1984)
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