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Acoustic Neuromas: General Considerations

I. Doğan, Burak Ozaydin, J. Roche, M. Başkaya
Published 2019 · Medicine

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VS account for approximately 6–8% of intracranial tumors in adults and are the most common tumor in the CPA ranging between 80% and 95%. Vestibular schwannomas constitute 6% of all intracranial neoplasms and are the most common benign lesions of the IAC and CPA cistern constituting between 60% and 90% of the entire lesions seen in this area. Growth rates in tumors that exhibit enlargement have been reported to be about 1–2 mm per year in linear growth in at least one dimension. While no formal consensus exists, most authors define normal growth rates as being between 1 and 2 mm per year and fast growth rates as 4 mm or greater per year. When considering common presenting manifestations, a helpful framework is to consider manifestations based on the size of the tumor, and its location; intracanalicular, cisternal, brainstem compressive, or hydrocephalic sizes. While any configuration is possible, hearing loss associated with vestibular schwannomas of this size is typically unilateral, progressive, and commonly affects high-frequency thresholds and speech perception. An occipital headache attributable to the tumor is a late finding with 20% of patients with tumors between 1 and 3 cm, with 40% of patients with tumors larger than 3 cm verifying this symptom. Gross total resection is the goal of surgery while maintaining good facial function, in all sizes of tumors, and hearing preservation, in small to moderate size tumors in patients with serviceable preoperative hearing status.
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