Download Acoustic Neuroma

Cranial Nerve Lesion
Acoustic Neuroma
Presented By:
Emma Morales
Gigi Sanchez
Christine Achenbach
Josefina Delgado
Introduction of Cranial Nerve
Eight: Vestibulocochlear Nerve
 Arises in the inner ear and goes to the
pons
 Two anatomically and functional parts:
Cochlear Nerve
 Vestibular Nerve
 Cranial Nerve XIII functions in hearing and
balance
Vestibulocochlear Nerve VIII
Clinical Case of Acoustic
Neuroma (Vestibular Shwannoma)
Robin
• European-American woman
• 51 years old
• Professional Executive
• Maintained reasonable diet
• Overall in perfectly good health
Robin’s Symptoms
• Symptoms started 2 years ago
–telephone communication
distorted -right ear
–tinnitus-right ear
–dizzy spells at work
–bumping into things everywhere
Robin’s visit to General Physician
• First General Physician
• diagnosed her with inner ear
imbalance from her last plane trip
• Antivert medication was prescribed
• no change in symptoms
• Second Physician
• MRI scan
• found small 0.9cm Acoustic Neuroma
Background:
What is Acoustic Neuroma?
 Non-cancerous tumor of the eighth
cranial Nerve leading from brain to
inner ear
 Usually grow slowly over a period of
years
 Not Hereditary: Occur spontaneously
without any evidence of inheritable
patterns
Common Symptoms
 Major symptom: Hearing Loss 95% of
those with tumor
 Tinnitus
 Vertigo
 Headaches
 Unsteadiness-poor coordination
 Facial numbness, tingling, twitching
Signs of Acoustic Neuroma
Decreased speech discrimination
Nystagmus
Abnormal facial electromyogram
Statistical Information
 Found in autopsy in less than one in
one-hundred of the general population
 Hearing loss and symptoms occur in
about one person in 100, 000
 Diagnosed in patients between the
ages of 30-60
 Cause unknown
Clinical Findings: Test
ENG
(Electronystagmography
test)
Caloric Test
MRI scan
MRI Classification for AN
 Entirely Intracanicular
 Intercranial extension without
brainstem distortion
 Intracranial extension with brainstem
distortion
Diagnosis: Findings on Clinical
Case
Detected small .9cm Acoustic Neuroma
affected hearing loss and balance
Treatment Options
 Observation
 Surgery- Microsurgical tumor removal
• Partial tumor removal
• Total tumor removal
 Radiation
• Gamma Knife
• FSR
Clinical Case Plan
 Patient Robin decided on RADIATION
 FSR treatment
• 5 treatments a week
• for 5 weeks
 Robin’s Follow-up
• 1 year - improved hearing
• 2 years – tumor reduced and 92% hearing back
• no significant side effects
Neurobiology of Acoustic
Neuroma: Structures Involved
 Eighth Cranial nerve
• Vestibular & Cochlear Divisions
Auditory Canal
Internal Auditory Canal
Growth patterns

Stage 1

Stage 2

Stage 3