Vestibular schwannoma

vestibulární schwannon, nezhoubný nádor rovnovážně-sluchového nervu, nemocnice Motol, Klinika otorinolaryngologie a chirurgie hlavy a krku 1. LF UK a FN v Motole

Vestibular schwannoma

Vestibular schwannoma is a benign tumour that arises from cells that surround the fibres of the cochleovestibular nerve, which transmits information from the inner ear to the central nervous system.

In the Czech Republic, about 200-400 people get sick with this type of tumour every year. Its most common manifestations include unilateral hearing impairment, tinnitus, and balance impairment. Hearing loss tends to be progressive and inconspicuous at first, and may first manifest itself, for example, when talking on the phone.

Over time, difficulties with localisation of sound and understanding speech in a noisy environment appear. Eventually, there may be complete hearing loss on the affected side.

Difficulties in the sense of dizziness or instability affect approximately half of the patients, but tend to be of a mild nature. Really large tumours can also manifest themselves with other neurological symptoms, especially impaired sensitivity of the face, headaches, deterioration of vision, mobility, speech, and, in the worst case, impaired consciousness.

vestibulární schwannom - audio vyšetření sluchu

Treatment options

Patients with vestibular schwannoma come to a specialised consultation room, where the nature of the disease and its treatment are explained to them. Together with the patient, the doctor then chooses the most suitable procedure. Nowadays, there are three basic therapeutic approaches: monitoring (“wait and scan”), microsurgical removal of the tumour, and stereotactic radiotherapy. The size of the tumour and its growth activity, the condition of the hearing and balance system, the patient’s age, his general health, and the patient’s preferences play a role in the decision. The choice of a treatment procedure is therefore a complex and individual process, and the optimal procedure cannot be determined in advance without a proper examination.

vestibulární schwannom - kontrolní (opakované) magnetické rezonance a vyšetření sluchu

Follow-up “wait and scan” – we choose in patients with a smaller tumour, without hearing impairment, or in patients for whom surgery would be too risky. We perform control (repeated) magnetic resonance imaging and hearing assessment. The first imaging examination will most often take place 6 months after diagnosis. If the tumour does not grow during this period
of time, the patient is monitored by magnetic resonance at regular annual intervals
for a minimum of 3 years. If the tumour continues to grow, we can consider extending the follow-up interval.

Stereoradiotherapy – targeted application (single session) of a high dose of ionising radiation to the tumour area to stop its growth. One of the most commonly used systems is Leksell’s Gamma knife and CyberKnife. The advantage of this modality is the short duration of treatment without the need for general anaesthesia. In the case of vestibular schwannomas, we choose this procedure for small and medium-sized growing tumours. Irradiation does not remove the tumour, its growth activity is stabilised.


Microsurgical resection, its goal is radical removal of the tumour under microscopic control. It is indicated primarily for more advanced and growing tumours. For small tumours, we indicate surgery if we are trying to save deteriorating hearing or improve balance problems. It is a procedure under general anaesthesia in which doctors specialising in otorhinolaryngology and neurosurgery collaborate. During the procedure, surgeons try to preserve the function of the adjacent structures as much as possible, especially the facial nerve and, in case of favourable hearing, also the auditory nerve.


Surgical treatment



Postoperative rehabilitation focusses mainly on balance and hearing. During radical surgery, the balance nerve from which the tumour grows must be cut. This results in varying degrees of imbalance in patients. With well-planned rehabilitation, in most cases the balance disorder can be very well compensated for by strengthening other components of the balance system. However, early rehabilitation is important under
the guidance of an experienced rehabilitation worker. We usually use virtual reality in these situations, which helps patients manage previously common but now problematic situations, such as riding on escalators or driving a car.


In the event that patients no longer hear in the affected ear, compensation can be accelerated even before surgery by applying an ototoxic antibiotic to the middle ear. This will gradually eliminate the balance apparatus on the affected side. With targeted exercises, the patient achieves compensation of the balance system before surgery, and the postoperative period is then less burdensome for him.

The most common symptom of vestibular schwannoma is hearing impairment. All treatments carry the risk of further hearing loss. There are several ways, how to deal with the hearing loss in affected patients. The simplest method is a hearing aid that acts as a sound amplifier. If the ear is already deaf, different systems can be used to transfer sounds from the deaf side to the hearing side. Two hearing aids that communicate with each other (CROS) or a bone hearing aid that stimulates the inner ear
of the healthy side (BAHD) can be used (Fig). If the auditory nerve is preserved during the operation, then a cochlear implant can also be used. It is the only method that can restore full hearing to the affected party in this case. In case of hereditary occurence of vestibular schwannoma
(Neurofibromatosis type 2) and bilateral deafness, we can consider auditory brainstem implant.



At the present time

In 2023, a total of 40 patients with vestibular schwannoma were operated on at the Department of Otorhinolaryngology and Head and Neck Surgery 1st Faculty of Medicine, Charles University and University Hospital Motol. At the same time, the Schwannoma team celebrated 25 years of work. More on the website of UH Motol.


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