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Neurinoma: Causes, Symptoms & Treatment

A neurinoma is a benign tumor arising from Schwann cells of peripheral nerves. It most commonly affects the auditory nerve, causing hearing loss, tinnitus, and dizziness.

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Things worth knowing about "Neurinoma"

A neurinoma is a benign tumor arising from Schwann cells of peripheral nerves. It most commonly affects the auditory nerve, causing hearing loss, tinnitus, and dizziness.

What is a Neurinoma?

A neurinoma (also called a schwannoma) is a predominantly benign tumor that develops from Schwann cells -- the cells that form the myelin sheath surrounding peripheral nerve fibers. These tumors typically grow slowly, displacing rather than invading surrounding tissue. The most common type affects the eighth cranial nerve (the vestibulocochlear nerve) and is known as a vestibular schwannoma or acoustic neuroma.

Causes

The exact cause of neurinomas is not always fully understood. Key contributing factors include:

Genetic factors: In the hereditary condition Neurofibromatosis Type 2 (NF2), bilateral neurinomas frequently develop due to a mutation in the NF2 gene on chromosome 22.
Sporadic mutations: Most neurinomas occur without a family history and arise from spontaneous, random genetic changes in Schwann cells.
Radiation exposure: Previous radiation therapy to the head and neck region is considered a possible risk factor.

Symptoms

Symptoms of a neurinoma depend on which nerve is affected. The most common form -- the acoustic neuroma -- typically presents with:

Unilateral hearing loss (often gradual in onset)
Tinnitus (ringing or buzzing in one ear)
Dizziness and balance disturbances
Facial numbness or tingling
In larger tumors: headaches and coordination difficulties due to pressure on adjacent brain structures

Neurinomas affecting other nerves (e.g., along the spine or peripheral nerves) may cause pain, numbness, or muscle weakness in the area supplied by the affected nerve.

Diagnosis

Several diagnostic methods are used to identify a neurinoma:

Magnetic Resonance Imaging (MRI): The gold standard investigation, providing detailed visualization of the tumor and its location.
Computed Tomography (CT): Used as a complementary method, especially for assessing bony structures.
Audiometry (hearing test): To detect and quantify hearing loss in cases of acoustic neuroma.
Balance testing: For example, electronystagmography to assess vestibular function.
Biopsy / histological examination: Provides definitive diagnosis following surgical removal of the tumor.

Treatment

Treatment depends on the size, location, and growth rate of the tumor, as well as the overall health of the patient. The main treatment options include:

Watch and Wait

For small, slow-growing tumors with minimal symptoms, a strategy of regular monitoring with MRI scans may be appropriate, particularly in older patients.

Surgical Removal

Microsurgical resection is the standard treatment for symptomatic or growing neurinomas. The goal is complete removal of the tumor while preserving the function of adjacent nerves as much as possible.

Radiation Therapy / Radiosurgery

Stereotactic radiosurgery (e.g., Gamma Knife) is a non-invasive alternative to surgery, using highly focused beams of radiation to stop tumor growth. It is particularly suitable for small to medium-sized tumors or for patients who are not ideal surgical candidates.

Prognosis

The prognosis for neurinomas is generally favorable, as these are mostly benign, slow-growing tumors. Successful long-term tumor control is achievable in most cases following treatment. Regular follow-up examinations are important to detect any recurrence early.

References

Jackler RK, Pitts LH. Acoustic neuroma. In: Cummings Otolaryngology. 7th ed. Elsevier; 2021.
World Health Organization (WHO). Classification of Tumours of the Central Nervous System. 5th ed. IARC Press; 2021.
Stangerup SE, Caye-Thomasen P. Epidemiology and natural history of vestibular schwannomas. Otolaryngol Clin North Am. 2012;45(2):257-268. PubMed PMID: 22483814.

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