Intralabyrinthine Vestibular Schwannomas: Classification and Management

 

Small vestibular schwannomas are rare tumors and frequently missdiagnosed with other ear diseases. The best treatment option remains unclear.

Objective: To present a clasification based on tumor location within the labyrinth and review the presenting symptoms, diagnostic tools and strategy for surgical treatment of these small vestibular schwannomas.

Results: In a larger series of 556 operated vestibular schwannoma there were only 4 cases of intralabyrinthine tumors. Unilateral hearing loss and vertigo were the symptoms of all patients. These four patients were initially treated for different pathologies. Indication for surgery was intractable vertigo and tinnitus. All patients were deaf before microsurgical resection.

Conclusion: MRI examination of the inner ear with gadolinium should be carried out for patients complaining of unilateral tinnitus, progressive hearing loss and vertigo. Small intralabirynthine schwannomas may be overlooked if a high-resolution MRI examination is not performed. Management of these tiny tumors is controversial, because the natural history of these schwannomas is not well known. Most patients are already deaf at diagnosis and intractable vertigo or tinnitus may be the indication for treatment. Clinical observation, surgicall resection and radiosurgery are the options.