Schwannoma natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maneesha Nandimandalam, M.B.B.S.[2]

Natural history

More than half of all VS grow at an average of 2–4 mm/year, whereas less than 10% regress27. One study revealed that extrameatal tumors (28.9%) were more likely to grow compared to intrameatal tumors (17%) and a larger percentage of tumors grew early on after detection28. VS >2 cm are more likely to grow compared to smaller VS29–30. Growth rates of >2 mm/year are associated with decreased rates of hearing preservation compared to slower growth rates31

Clinical presentation

Presentation depends on the location of the tumor (see below) but generally, symptoms are due to local mass effect or dysfunction of the nerve they arise from.

Symptoms of schwannoma depend on the location of the tumor.

• Intracranial schwannoma:

• Acoustic neuroma (most common)

• Sensorineural hearing loss
• Vertigo
• Tinnitus
• Facial weakness
• Facial numbness and tingling
• Headaches
• Dizziness
• Difficulty swallowing and hoarseness
• Taste changes
• Confusion

• Trigeminal schwannoma

• Trigeminal nerve dysfunction

• Facial nerve schwannoma

• Facial nerve dysfunction

• Jugular foramen schwannoma

• Hearing loss
• Tinnitus
• Dysphagia
• Ataxia
• Hoarseness

• Hypoglossal schwannomas

• Hypoglossal nerve dysfunction

• Spinal schwannoma

• Back pain
• Urinary incontinence
• Urinary retention
• Clumsiness
• Weakness
• Paresthesias

• Intercostal nerve schwannoma

• Usually asymptomatic

• Intramuscular schwannoma

• Painless mass

References

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