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Vestibular Schwannoma
----Clinical History: 44-year-old male with progressive right-sided sensorineural hearing loss.
----Radiologic Findings: T1-weighted images (Figs. 1 and 2) show a 4 cm x 3 cm right cerebellopontine
angle (CPA) mass with decreased signal intensity. It extends into the porous acousticus and maintains
acute angles with the petrous bone. A moderate amount of mass effect involves the pons and cerebel-
lum. A T2-weighted image (Fig. 3) demonstrates heterogeneously increased signal intensity in the mas
-s. Following Gadolinium administration, T1-weighted images (Figs. 4 and 5) show intense homogeneo-
-us enhancement of the mass.
(Figs.1)
(Figs.2)

(Figs.3)
(Figs.4)

 
(Figs.5)
----Diagnosis:Vestibular Schwannoma.
----Discussion:Vestibular schwannomas are the most common tumors of the CPA, accounting for 80-
90% of all tumors in this location. They most commonly arise from superior vestibular branch of the 8th
nerve, slightly more commonly than inferior vestibular nerves. The 5th and 7th nerves are the next mo-
st common nerves of origin of schwannomas.
----Schwannomas arise from perineural Schwann cells, which are responsible for myelination of per-
ipheral nerves. Although "neuroma" tends to be used interchangeably with "schwannoma", by strict
pathologic definition, neuromas refer to a post-traumatic proliferation of nerve cells rather than a true
neoplasm.
----Arachnoid cysts co-exist in 7-10% of cases of vestibular schwannoma. Bilateral vestibular schwa-
nnomas are the primary diagnostic criterion for type 2 neurofibromatosis.
----The differential diagnosis includes a meningioma, which maintains obtuse angles with the petrous
bone and exhibits the dural tail sign. An epidermoid, an aneurysm, and a metastasis is also noted in the
differential.
References:
1. Willing, Atlas of Neuroradiology, W. B. Saunders, Philadelphia, PA, 1995, pgs. 153-155.
2. Grossman and Yousem, Neuroradiology: The Requisites, Mosby Year Book, St. Louis, MO,1994 ,pgs
73-74.
 
Rakesh Shah, M.D.
Charles F. Lanzieri, M.D.
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