Schwannoma natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maneesha Nandimandalam, M.B.B.S.[2]

Natural history

More than half of all VS grow at an average of 2–4 mm/year, whereas less than 10% regress27. One study revealed that extrameatal tumors (28.9%) were more likely to grow compared to intrameatal tumors (17%) and a larger percentage of tumors grew early on after detection28. VS >2 cm are more likely to grow compared to smaller VS29–30. Growth rates of >2 mm/year are associated with decreased rates of hearing preservation compared to slower growth rates31

Clinical presentation

Presentation depends on the location of the tumor (see below) but generally, symptoms are due to local mass effect or dysfunction of the nerve they arise from. ^[1]

Symptoms of schwannoma depend on the location of the tumor.

Intracranial schwannoma:

Acoustic neuroma (most common)

Sensorineural hearing loss
Vertigo
Tinnitus
Facial weakness
Facial numbness and tingling
Headaches
Dizziness
Difficulty swallowing and hoarseness
Taste changes
Confusion

Trigeminal schwannoma

Trigeminal nerve dysfunction

Facial nerve schwannoma

Facial nerve dysfunction

Jugular foramen schwannoma

Hypoglossal schwannomas

Hypoglossal nerve dysfunction

Spinal schwannoma

Intercostal nerve schwannoma

Usually asymptomatic

Intramuscular schwannoma

Painless mass

Complications

Besides the complications that are directly produced the schwannoma itself due to it mass affect, there are many other complications that may arise post-surgical or post-radiation therapy depending on the anatomic location of the tumor. ^[2]

Surgical complications:

Peri-operative hemorrhage
CSF leaks
Infections

Prognosis

Schwannomas are slow growing tumors.
The rate of recurrence after resection is extremely low. ^[3]
They almost never turn malignant.

References

↑ Matthies C, Samii M (January 1997). “Management of 1000 vestibular schwannomas (acoustic neuromas): clinical presentation”. Neurosurgery. 40 (1): 1–9, discussion 9–10. doi:10.1097/00006123-199701000-00001. PMID 8971818.
↑ Yashar P, Zada G, Harris B, Giannotta SL (September 2012). “Extent of resection and early postoperative outcomes following removal of cystic vestibular schwannomas: surgical experience over a decade and review of the literature”. Neurosurg Focus. 33 (3): E13. doi:10.3171/2012.7.FOCUS12206. PMID 22937847.
↑ Senapati SB, Mishra SS, Dhir MK, Patnaik A, Panigrahi S (2016). “Recurrence of spinal schwannoma: Is it preventable?”. Asian J Neurosurg. 11 (4): 451. doi:10.4103/1793-5482.145060. PMC 4974985. PMID 27695564.

Template:WikiDoc Sources

[pmid8971818-1] Matthies C, Samii M (January 1997). “Management of 1000 vestibular schwannomas (acoustic neuromas): clinical presentation”. Neurosurgery. 40 (1): 1–9, discussion 9–10. doi:10.1097/00006123-199701000-00001. PMID 8971818.

[pmid22937847-2] Yashar P, Zada G, Harris B, Giannotta SL (September 2012). “Extent of resection and early postoperative outcomes following removal of cystic vestibular schwannomas: surgical experience over a decade and review of the literature”. Neurosurg Focus. 33 (3): E13. doi:10.3171/2012.7.FOCUS12206. PMID 22937847.

[pmid27695564-3] Senapati SB, Mishra SS, Dhir MK, Patnaik A, Panigrahi S (2016). “Recurrence of spinal schwannoma: Is it preventable?”. Asian J Neurosurg. 11 (4): 451. doi:10.4103/1793-5482.145060. PMC 4974985. PMID 27695564.

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