Vestibular Schwannoma

What is a vestibular schwannoma?

Vestibular schwannomas start in Schwann cells. These are cells that help to protect and support the nerve.

Usually, vestibular schwannomas develop in the Schwann cells covering the vestibulocochlear nerve. The vestibulocochlear nerve connects the brain to the inner ear. It controls hearing and balance.

Vestibular schwannomas do not spread to other parts of the body. Because they grow slowly over some years, you don’t usually have symptoms for some time.

When you do have symptoms, they can be:

• hearing loss that usually affects one ear

• ringing and buzzing sounds in 1 or both ears (tinnitus)

• difficulty working out where sounds are coming from

• dizziness or vertigo and problems with balance

• numbness of the face

Find out more about the differences between benign and malignant brain tumours

How common it is

Vestibular schwannomas are rare tumours. The risk of developing this tumour increases as you get older. The risk is greatest in those aged between 65 and 74 years old.

Rarely, vestibular schwannomas are caused by a genetic condition called NF2-related schwannomatosis. People with this condition are often diagnosed at a younger age with:

• several benign tumours of the brain and spinal cord and

• vestibular schwannomas in the nerves on both sides of the head (bilateral)

What tests will I have?

You have tests to diagnose a vestibular schwannoma. Your doctor checks the size of the tumour and its location. This helps your doctor plan your treatment. The tests you might have include:

• hearing tests

• MRI scan

• CT scan

We have information about having MRI scans and CT scans in the getting diagnosed section

Treatment

Your treatment plan depends on several factors including:

• the size of your tumour

• the symptoms you have

• your age

• your preferences

The team caring for you will talk to you about your treatment. They will consider the risk of further hearing loss as well as what you want.

You might not need treatment straight away and your doctors monitor you. Or you might have surgery or radiotherapy.

Monitoring

For a very small vestibular schwannoma, you might not need treatment straight away. Your doctor might recommend monitoring the tumour with regular MRI scans. This is called active surveillance. Your specialist will let you know how often you have your MRI scans.

Many small tumours don’t grow. If you are worried about symptoms between your appointments, contact your specialist. You might continue with monitoring. But it may be a sign that the tumour is growing and you might need treatment with either surgery or radiotherapy.

Surgery

A brain specialist surgeon (neurosurgeon) might remove all the tumour or just a part. This depends on where the tumour is and its size.  

There are different types of surgery that you can have. A common type is removing the tumour through a hole in your skull. This is usually a small cut above your ear or behind your ear.

To remove the tumour, it may be necessary to cut the hearing and balance nerve on the side where the tumour is. Your neurosurgeon will discuss the options with you. 

You might have side effects after the operation. The side effects can include:

• hearing loss on the side of the surgery, where the tumour was removed

• problems with balance

• infection of the membranes that surround the brain (meningitis)

• headaches and neck pain

• drooping of the face (facial palsy)

• tinnitus

Read more about surgery for brain tumours

Targeted radiotherapy

Radiotherapy means the use of radiation, usually X-rays, to treat cancer.

You might have one treatment. This is called stereotactic radiosurgery (SRS). Or you might have several treatments called stereotactic radiotherapy (SRT).

Your treatment depends on the size of the tumour and where it is. Both treatments target high doses of radiotherapy to the tumour.

The radiotherapy can stop the tumour growing and may reduce it in size.

Your specialist will tell you how long your treatment will last and what type of radiotherapy you will have.

Side effects of radiotherapy

The side effects depend on the type of treatment you have. They might include:

• hearing loss

• tiredness and fatigue

• feeling sick

• headaches

• hair loss - in the treated area

• skin problems in the area being treated – the skin can become dry and red. This usually improves a couple of weeks after the treatment has finished

• facial weakness

Your radiotherapy team will explain more about your radiotherapy and the possible side effects.

We have information about stereotactic radiotherapy and radiosurgery

Driving

You do not usually need to let the DVLA or DVA know if you have a vestibular schwannoma. But you must let them know if you’ve experienced sudden dizziness. Or you have a vestibular schwannoma in both ears.

Speak to your specialist nurse or doctor for advice if you are unsure about your symptoms.

Coping with vestibular schwannoma

Coping with a diagnosis of a brain tumour can be difficult, both practically and emotionally. It can be especially difficult when you have a rare tumour. Being well informed about the type of tumour you have, and its treatment can make it easier to cope.

Find out what you can do, who can help and how to cope with a brain tumour