Acoustic neuroma staging

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Acoustic neuroma may be classified into three subtypes based on tumor size and into six subtypes based on tumor location.

Staging

For better description of patients' status then analyzing management strategy and outcome of the treatment, standardized grading for main symptoms have been made. Generally, the AAO-HNS Hearing Classifi- cation System,6 House-Brackmann Facial Nerve Grading System,7 Tinnitus Handicap Inventory8 and Dizziness Handicap Inventory9 are widely accepted and used for Acoustic neuroma.

Tinnitus grading system for acoustic neuromas
Grade	Description
I	No tinnitus
II	Intermittent or mild tinnitus, can only be heard when the ambient noise is low
III	Persistent or moderate tinnitus, can be heard every day
IV	Persistent and severe tinnitus, interfere with work and sleep

Dizziness grading system for acoustic neuromas
Grade	Description
I	No dizziness or imbalance
II	Occasional and mild dizziness or imbalance
III	Persistent or moderate vertigo or imbalance
IV	Persistent and severe dizziness or imbalance, disturbing daily life

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Main grading systems for acoustic neuromas
Tumor size (CPA Maximum diameter)	Sterker	House	Koos	Samii	Tumor Description
0 (intracanalicular)	Tube type	intracanalicular	Grade I	T1	Confining to IAC
≤10 mm	Small	Grade 1 (Small)	Grade II	T2	Superpassing IAC
≤15 mm		Grade 2 (Medium)		T3a	Tumor occupying CPA
≤20 mm	Mild
≤3o mm		Grade 3 (Moderately Large)	Grade III	T3b	Tumor occupying CPA and contacting the brainstem without compression
≤40 mm	Large	Grade 4 (Large)	Grade IV	T4a	Tumor compressing the brainstem
>40 mm	Huge	Grade 5 (Giant)		T4b	sever brainstem displacement and deformation of fourth ventricle under tumor compression