Acoustic neuroma differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

Acoustic neuroma must be differentiated from meningioma, intracranial epidermoid cyst, facial nerve schwannoma, trigeminal schwannoma, ependymoma, leiomyoma, intranodal palisaded myofibroblastoma, malignant peripheral nerve sheath tumour (MPNST), gastrointestinal stromal tumor, neurofibroma, Meniere's disease, and Bell's palsy.

Differential Diagnosis

Acoustic neuroma must be differentiated from:

• Meningioma
• Intracranial epidermoid cyst
• Facial nerve schwannoma
• Trigeminal schwannoma
• Ependymoma
• Metastasis
• Leiomyoma
• Intranodal palisaded myofibroblastoma
• Gastrointestinal stromal tumor
• MPNST - schwannoma with ancient change has no significant mitotic activity
• Neurofibroma
• Meniere's disease
• Bell's palsy

Differentiating features of common differential diagnosis are:

Disease/Condition	Differentiating Signs/Symptoms	Findings on CT or MRI
Meningioma	Hearing loss is a less prominent	Usually more homogeneous in appearance: significant signal heterogeneity with cystic or haemorrhagic areas is more typical of vestibular schwannoma than meningiomas (although cystic meningiomas do occur) Meningiomas tend to have a broad dural base Usually lack trumpet IAM sign Calcification is more common
Intracranial epidermoid cyst	Hearing loss is less	No enhancing component Very high signal on DWI (Diffusion weighted imaging) Does not widen the IAC (Internal auditory canal)
Facial nerve schwannoma	Facial weakness is prominent and occurs early Sometimes associated with neurofibromatosis	CT and MRI imaging results are similar to acoustic neuroma but enhancement extends into the geniculate ganglion of the facial nerve and facial canal
Trigeminal schwannoma	Clinically associated with more prominent facial numbness Hearing loss is also less prominent	CT and MRI imaging displays a dumbbell-shaped mass over the petrous apex affecting Meckel cave. The trigeminal nerve enhancement extends proximal to the tumor and does not extend into the IAM (internal acoustic meatus)