Acoustic neuroma ....,..................

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1. PRESENTED BY -JYOTI DHYANI
DEPT. OF SHALAKYA TANTRA
PATANJALI AYURVEDA COLLEGE

3. The vestibulocochlear
nerve is made up of
cochlear nerve and
the vestibule nerve. It
is the 8
th
cranial nerve.
It connects the inner
ear organ to the
brainstem and is
responsible for
relaying auditory and
balance information
to the brain.

4. Tumour of eighth
cranial nerve
originates from
schwanncell.
▪synonyms-
Vestibular
schwannoma
Neurilemmoma

5. ▪Idiopathic-There is no known cause of acoustic
neuroma.
▪Exposure of high dose radiation-is the only
known environmental risk factor for acoustic
neuroma.
▪Gene malfunctioning-Patient with
neurofibromatosis Type II have a
malfunctioning gene on chromosome 22. these
patients can develop acoustic neuromason
both sides of the head.

6. Acoustic neuromaconstitutes 80% of all
cerebellopontineangle tumors and 10% of all
brain tumors.

7. CPA is irregularly shaped potential space in
the posterior fossain the brain.
Anteriorly-Posterior surface of temporal bone.
Posteriorly-Anterior surface of the cerebellum.
Medially-Cistern in the ponsand medulla.
Superiorly-inferior border of ponsand
cerebellum.

9. NF2 gene, located on chromosome 22 produces
merlin, also known as schwannomin, a cell
membrane related protein that acts as a tumour
suppressor.
Biallelicinactivation of the NF2 gene is found in
most sporadic vestibular schwannomas.

10. ▪Gross-It is benign,
encapsulated,
extremely slow
growing tumour of
the eighth nerve.

11. ▪Microscopically-it
consists of
elongated spindle
cells with rod
shaped nuclei lying
in rows or
palisades. The
unilateral tumours
are more common.
Bilateral tumours
are seen in patients
with
neurofibromatosis.

12. The tumour almost always arises from the
schwanncells of the vestibulocochlearnerve
with in the internal auditory canal.
As it expands, it causes widening and erosion
of the canal and then appears in the CPA angle.
It may grow anterosuperiorly-Vthnerve
inferiorly-IX, X, XI cranial nerves.
In later stages, it cause displacement of
brainstem, pressure on cerebellum and raised
intracranial tension.

13. The growth of the tumour is extremely slow and
history may extend overseveral years.

14. ▪Intracanalicular-
hearing loss, tinnitus, vertigo
▪Cisternal-
Worsened hearing and dysequilibrium
▪Compressive-
Occasional occipital headache.
Corneal hyperesthesia.
▪Hydrocephalic-
Fourth ventricle depressed and obstructed.
Headache, visual changes, altered mental
status.

19. Age and sex –tumour is mostly seen in age
group of 40-60 years. Both sexes are equally
affected.
Cochleovestibularsymptoms –
-sensory neural hearing loss, unilateral
-tinnitis
-unsteadyness
Cranial nerve involvement-
-5
th
CN –numbness of face
-reduced corneal reflex
-7
th
CN –Hitzelburger’ssign

20. -loss of taste sensation
-reduced lacrimation
-delayed blink reflex
-9
th
and 10
th
CN –dysphasia
-horsenessof voice
-11
th
, 12
th
,3
rd
,4
th
,6
th
CN –if tumour is very large.
Brainstem involvement –
-ataxia
-weakness and numbness of arms and legs
-exageratedtendon reflex

21. Cerebellarinvolvement –
-finger-nose test
-knee-heel test
-dysdiadokinesia,
-ataxic gait
-inability to walk along a straight line
Raised ICP –
-headache
-vomiting
-diplopiadue to 6
th
nerve involvement
-papilloedemawith blurring of vision

22. History
Investigation
History
Unilateral or bilateral sensorineuralhearing
loss, tinnitus with imbalance.

23. Audiologicaltests-
PTA
Speech audiometry
Roll over phenominon
Recruitment
SISI
Threshold tone decay test
Stapedialreflex decay test
Brain stem evoked response audiometry

24. In acoustic neuroma, PTAwill show sensorinural
hearing loss, more marked in high frequencies.

25. speech audiometryshows poor speech
descriminationand this is disproportionate to
pure tone hearing loss.

26. Roll over phenomenon i.e. Reduction of
descriminationscore when loudness is
increased beyond a particular limit is most
commonly observed.

28. Measure of nerve fatigue
Use to detect retrocochlearlesions
Normally, a person can hear a tone
continuously for 60s
In nerve fatigue, the person stops hearing
earlier
The result of the test is expressed as number of
dB of decay
A decay of > 25 dB diagnostic of retrocochlear
lesion

31. It is very useful in the diagnosis of
retrocochlearlesions. In the presence of 8
th
nerve tumour, a delay of >0.2 ms in wave V
between two ears is significant.

33. Caloric test-
Diminished or
absent response in
96%
of patients. May be
normal when tumour
is small.

34. Complete examination of
-Cranial nerves
-Cerebellarfunctions
-Brainstem signs
-Fundusis examined for
blurring of disc margins
or papilloedema

35. Plain x-ray
CT scan
MRI with gadolinium contrast
Vertebral Angiography

36. It is superior to CT scan
and is the gold standard
for diagnosis of acoustic
neuroma.
Intracanaliculartumour,
of even a few
millimetres, can be
easily diagnosed by
this method.

38. Surgical
Radiological

41. 1-Conventional radiotherapy
2-X-knife or gamma knife surgery
3-Cyber knife
1-Conventional Radiotherapy-not preferred now
due to low tolerance of CNS to radiation.

42. 2-X-knife or Gamma knife
surgery-
Stereotactic Radiotherapy
Advantages-
1 Minimal Radiological effect
2 Causes reduction in tumour
size and growth
3 Can be used in patients
where surgery is not feasible
X-knife –Linear accelerator
Gamma knife-Cobalt 60

43. 3-Cyber knife Radiation-
Modified X-knife
More accurate and
frameless
It uses real time images
guidance technology
through computer
controlled robotics.

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54. Thank You