Diagnosis of vestibular schwannomas should begin with a thorough physical examination. Physicians should pay special attention to hearing and balance, the eyes, the cranial nerves, and the skin. Once diagnosed the tumor can be removed in a majority of patients by a variety of surgical techniques while potentially preserving neurological function. Advances in microsurgical techniques, anesthesia, and care during the operation, have significantly reduced the morbidity and mortality for vestibular schwannoma surgery and enabled total removal in a majority of cases. When MRI shows a tumor larger than two centimeters or when the tumor fills the internal auditory canal, surgery may result in the loss of useful hearing.
Surgery is also important in patients with growing tumors.
There are, however, some patients who may not be eligible for surgery or who may be at a greater risk for complications from surgery. Finally, observation, radiation therapy, including stereotactic radiosurgery, particle beam therapy, and photon beam therapy, are options for those who cannot tolerate surgery. The panel recommended areas in which future research should focus. These include tumor classification by size and location, establishment of a national registry and tissue repository, identification of the NF2 gene, and research to devise noninvasive treatments to arrest tumor growth. This 3-day Consensus Development Conference on Acoustic Neuroma was sponsored by the National Institute of Neurological Disorders and Stroke, the National Institute on Deafness and Other Communication Disorders, the National Cancer Institute, and the NIH Office of Medical Applications of Research.