Acoustic neuromas and vestibular schwannomas are benign tumors that do not metastasize (grow into other organs or systems). Tumor growth, current symptoms, and your individual needs play a key role in the treatment decision. Here you can learn more about the most common symptoms, causes, and individual treatment options.
We have already treated over 2,5000 patients with acoustic neuromas at ERCM. We can therefore offer you extensive experience with robot-guided, high-precision CyberKnife therapy and ZAP-X therapy for this disease.
Discover a very gentle and effective tumor therapy with the innovative radiosurgical treatment.
Acoustic neuromas—medically known as vestibular schwannomas —are among the rarer tumors that originate from certain cells (Schwann cells) of the paired vestibulocochlear nerve, the VIIIth cranial nerve [1]. This cranial nerve consists of various components responsible for human hearing and balance sensations.
There is approximately one new case per 100,000 inhabitants annually [2]. Acoustic neuromas, which are usually small, grow very slowly, averaging approximately 1 to 2 mm per year. However, they do not grow continuously. We also see cases where they do not increase in size for months or even years before finally experiencing a new growth spurt. In general, we recommend always seeking advice about all available treatments.
Many patients remain completely symptom-free for years [3]. For this reason, the disease is often only monitored during follow-up visits. At ERCM, we are often asked when an acoustic neuroma actually requires surgery.
Ultimately, your personal preferences always play a role in which therapy you choose in consultation with your doctors – for example, which option can also relieve you of emotional burden.
In small and medium-sized acoustic neuromas, new study data for robot-guided radiosurgical treatment, and as an alternative to microsurgical surgery, demonstrate, for example, a significant reduction in tumor volume with mostly minor functional losses [3].
Especially for small acoustic neuromas, treatment with the high-precision CyberKnife or ZAP-X therapy is becoming increasingly popular, because it offers more efficient treatment and easier application compared to surgical tumor removal.
An acoustic neuroma is a benign tumor of nerve fibers originating from the cells of the nerve sheath (Schwann cells). It primarily affects nerve fibers of the auditory and vestibular nerves, which provide a connection between the inner ear and the brain.
Since the vestibular part, which is responsible for the sense of balance, is particularly affected, acoustic neuroma is predominantly referred to in medicine as vestibular schwannoma.
These benign tumors arise in the skull base, are rare, and account for 6% of all primary intracranial brain tumors. These tumors include all tumors that originate in the brain, the meninges, and pituitary structures (e.g., the pituitary gland).
The age at which patients are diagnosed is mainly between 50 and 70 years of age, but acoustic neuroma can occur at any stage of life [2].
Symptoms of nerve fiber tumors can vary and depend on the size of the acoustic neuroma and the affected cranial nerve.
The most common signs include:
The rather rare and non-specific symptoms include:
Once acoustic neuromas reach a certain size, they can also affect other cranial nerves. If, for example, the seventh cranial nerve (facial nerve) is affected, paralysis of the facial muscles, temporary visual disturbances, or impaired lacrimal gland secretion usually occur. However, this is very rare. Impairment of the fifth cranial nerve (trigeminal nerve) in larger tumors can lead to, among other things, facial numbness.
Swallowing difficulties may occur if the 9th (glossopharyngeal) and 10th (vagus) cranial nerves are affected. As the acoustic neuroma continues to grow, it not only presses on neighboring cranial nerves but also on the brainstem. This can increase intracranial pressure, leading to vomiting, headaches, and, in extreme cases, even loss of consciousness.
The causes of acoustic neuromas are currently unknown. A connection with neurofibromatosis—a group of rare genetic diseases characterized by growths of altered nerve tissue under the skin or in other parts of the body—has been documented.
For example, if the benign nerve fiber tumor is associated with type 1 neurofibromatosis (NF1) (Recklinghausen disease), the disease usually develops on only one side. Patients suffering from type 2 neurofibromatosis (NF2) usually have bilateral tumors.
Most acoustic neuromas are often diagnosed in the presence of dizziness, acute hearing loss, or as incidental findings during cranial magnetic resonance imaging (e.g., in the case of headaches). Family history is also important in cases of a familial or genetic predisposition to neurofibromatosis.
Imaging techniques are relevant to assessing how active the benign tumor is: Magnetic resonance imaging (MRI), for example, can detect acoustic neuromas with a diameter of only 1 to 2 mm.
Other examination methods include:
At ERCM, we often see patients who, although they don't exhibit symptoms, still feel a strong personal need to get rid of "that thing in my head." In our view, the goal should always be the best possible quality of life for each individual.
The most important therapeutic approaches include:
A surgical procedure for the neurosurgical removal of the acoustic neuroma usually requires a 1- to 2-week hospital stay.
Unlike conventional surgery, CyberKnife or ZAP-X therapy is performed on an outpatient basis. The painless, submillimeter-accurate, and precise procedure protects surrounding tissue as much as possible. Anesthesia is not required.
In over 90% of cases, a single precision treatment with the CyberKnife or ZAP-X is sufficient to eliminate the benign nerve fiber tumor. The treatment session lasts no longer than approximately 30 minutes and is therefore minimally invasive. In very rare cases, or with larger acoustic neuromas, multiple sessions may be necessary [4].
A recent study compared radiosurgical therapy with the wait-and-scan strategy: the controlled monitoring of acoustic neuromas. This approach also demonstrated better tumor control, comparable hearing preservation rates, and a significantly lower risk of neurological deficits or functional impairments. These results underscore the safety and efficacy of radiosurgery for acoustic neuromas [5].
Robot-guided radiosurgical treatment has the effect of causing tumor cells to die over time. This is clearly visible in an MRI scan: In the case shown, CyberKnife therapy (2007) not only stopped tumor growth, but the acoustic neuroma also shrank significantly over time (center image, 2009) and was barely visible in the subsequent course (2013) (right).
This video discusses the treatment options offered by CyberKnife therapy for patients with acoustic neuroma, together with our neurosurgical colleagues from the Großhadern Clinic of the University of Munich (LMU).
Information on robot-guided radiosurgery (e.g., CyberKnife treatment) for acoustic neuroma can also be found on the website of the non-profit patient self-help organization Vereinigung Akustikusneurinoma eV: www.akustikus.de.
Therapy options that have become more complex also mean that your personal decision for therapy should always be made with a view to your personal life situation. We accompany you on this path and advise you comprehensively with regard to the best possible treatment concept for you individually. Contact us and use our contact form.
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An acoustic neuroma is a benign and highly treatable tumor of the cerebellopontine angle. Various symptoms can occur, including hearing loss, unsteady gait, dizziness, or tinnitus. Headaches or a feeling of pressure in the ear are also typical.
Acoustic neuromas are benign, but due to their location in the brain, they can exert pressure on surrounding structures and cause symptoms. In very rare cases, they can grow more aggressively or invade other areas of the brain. The development of an acoustic neuroma into a malignant tumor is extremely rare and usually not observed.
The benign nerve fiber tumor grows very slowly, typically 1 to 2 mm per year. Acoustic neuromas also often grow in phases, with periods of little or no growth followed by periods of somewhat faster growth.
There is no evidence that alcohol or smoking promote the development of acoustic neuroma.
Yes, it is possible for an acoustic neuroma to regrow after treatment (surgery, radiation). The likelihood depends on several factors, including the type of treatment, the size of the original tumor, and the individual response to treatment.
Acoustic neuromas are benign tumors that grow slowly or remain stable. However, the likelihood of them regressing on their own in the long term without treatment is extremely low.
[1] Mohamad, J., Simgen, A., Differential diagnoses of acoustic neuromas. Radiologist 2020;60(11):1018-1025.
https://link.springer.com/article/10.1007/s00117-020-00751-w
[2] Kaschke, O., Steel, beam, or observation? Diagnosis and treatment of vestibular schwannoma. ENT News 2017;47(4).
https://www.springermedizin.de/vestibularisschwannom/vestibularisschwannom/diagnostik-und-behandlung-des-vestibularisschwannoms/13351614
[3] Wittenstein, O., Dunst, J., A wait-and-see approach or radiosurgery for asymptomatic vestibular schwannoma. Radiation Ther. Onkol. 2023;199(11):1031-1032.
https://link.springer.com/article/10.1007/s00066-023-02142-1
[4] Windisch, PY, Tonn, JC, Fürweger, C., Wowra, B., Kufeld, M. et al., Clinical Results After Single-fraction Radiosurgery for 1,002 Vestibular Schwannomas. Cureus. 2019;11(12):e6390.
https://www.cureus.com/articles/25873-clinical-results-after-single-fraction-radiosurgery-for-1002-vestibular-schwannomas#!/
[5] Bin-Alamer, O., Abou-Al-Shaar, H., Peker, S., Samanci, Y., Pelcher, I. et al., Vestibular Schwannoma International Study of Active Surveillance Versus Stereotactic Radiosurgery: The VISAS Study. Int J Radiat Oncol Biol Phys. 2024;120(2):454-464.
https://www.redjournal.org/article/S0360-3016(24)00482-6/abstract