Neuroma auditory nerve – cancer, manifested by symptoms of vestibular dysfunction. The neoplasm does not threaten the patient’s life, but significantly reduces the speed of perception audio information. This tumor develops from the cells of the myelin sheath of the eighth pair of cranial brain nerves.
The auditory nerve consists of the cochlear and vestibular branches. The first is responsible for transmitting sound information from inner ear in the brain, the second - for changing body position and balance. The neoplasm captures one of them or both at once, which is manifested by corresponding symptoms. Primary intracranial neoplasm was discovered by scientists in the late 18th century.
Neuroma is a dense node with an uneven, bumpy surface, surrounded by connective tissue. Inside it there are vessels, wen, cysts with fluid, fields of fibrosis. Tumor tissue gray with yellow and brownish-brown areas. These are fatty inclusions and traces of old hematomas. The bluish tint of the neoplasm is due to venous stagnation. Microscopically, neuroma consists of spindle-shaped polymorphic cells that form “polysade” structures with areas of hemosiderin accumulation surrounded by fibrous fibers. The tumor along the periphery contains a powerful vascular network. Its central sections are supplied with blood from single vessels or vascular tangles.
The neoplasm does not infiltrate surrounding tissues and rarely becomes malignant. The tumor may grow, but usually remains unchanged for a long time. In this case, it does not pose a danger to the patient’s life. As tumor tissue grows and the tumor increases in size, compression of the surrounding structures occurs, paresis of the facial and abducens nerves develops, which is clinically manifested by dysphonia, dysphagia, and dysarthria. When the brain stem is damaged, dysfunction of the respiratory and cardiovascular systems develops.
Acoustic neuroma usually develops in people during puberty, but is more often found in adults aged 30-40 years. In women, pathology occurs 2-3 times more often than in men. Unilateral acoustic neuroma- a sporadic disease that is not inherited and is not associated with other tumor diseases nervous system. Bilateral neuromas are a sign of neurofibromatosis, having a family predisposition and arising against the background of intracranial and spinal neoplasms. Head tumors always frighten patients, are difficult to treat and manifest severe clinical signs. Timely seeking medical help makes the prognosis of the pathology relatively favorable.
The cause of unilateral acoustic neuroma remains unknown at this time. A bilateral tumor is a manifestation of neurofibromatosis, a hereditary disease. As a result of mutation of certain genes, protein biosynthesis is disrupted, which limits tumor growth and leads to excessive proliferation of Schwann cells. At the same time, neurofibromas appear in various areas of the patient’s body. The pathology is inherited according to an autosomal dominant pattern. In patients with a genetic predisposition, neuromas, meningiomas, fibromas and gliomas of the back or skull appear by the age of 30. Most of them eventually lose their hearing.
nerve damage by tumor
Factors contributing to this mutation, causing uncontrolled cell division and provoking the development of neuroma of the vestibulocochlear nerve:
A small acoustic neuroma does not manifest itself clinically. Symptoms of the disease develop when the tumor compresses surrounding tissues. Early signs pathologies are: ear congestion, a feeling of pressure in the area of the inner ear, unusual sound sensations: squeaking, noise or ringing in the ears, as well as dizziness, unsteadiness of gait, nystagmus.
Stages of development of acoustic neuroma:
Hearing loss is caused by compression of the cochlear nerve. Hearing may decrease gradually or disappear suddenly. Hearing loss develops so slowly that patients do not notice this symptom for a long time. Over time, other functions of the auditory nerve disappear. Patients develop not only deafness, but also vestibular disorders.
Dizziness, nystagmus and unsteadiness of gait also develop gradually. In severe cases, vestibular crises occur, manifested by nausea, vomiting, and the inability to remain in an upright position.
To defeat facial nerve characteristic numbness of part of the face, discomfort tingling. Paresthesia and pain in the corresponding half of the face occur when the branches are compressed trigeminal nerve. Stupid and constant pain easily confused with toothache. It's a dull pain periodically intensifies and subsides. A large tumor leads to constant trigeminal pain radiating to the back of the head.
In patients, the corneal reflex weakens or disappears, the masticatory muscles atrophy, taste disappears, and salivation is impaired. Damage to the abducens nerve results in transient or persistent diplopia.
When a large neuroma compresses the respiratory and vasomotor centers, life-threatening complications develop: hyperreflexia, increased intracranial pressure, hemianopsia, scotomas.
If oncological pathology is suspected, a comprehensive and comprehensive examination of patients is carried out, including traditional methods and specialized research. Diagnosis of acoustic neuroma begins with listening to the patient’s complaints, collecting an anamnesis of life and illness, as well as a physical examination. During a neurological examination, a neurologist determines the functional abilities of the nervous system and the state of reflexes.
Additional research methods: audiometry, electronystagmography, radiography of the temporal bones. These methods are used on initial stages diseases.
Acoustic neuroma in the picture
More sensitive diagnostic techniques allow us to determine the location of the tumor, its size, and features:
Treatment of acoustic neuroma is carried out in various ways: medication, surgery, radiotherapy or radiosurgery.
Watchful waiting is indicated if the tumor is small and does not manifest itself clinically. This is especially true for elderly patients and people who, for health reasons, cannot undergo surgery. If the tumor was discovered by chance during a medical examination, medical tactics consist of monitoring the patient.
Drug therapy – prescribing medications to patients:
There are recipes traditional medicine which help stop tumor growth. The most common among them are: infusion of mistletoe, horse chestnut, Echinops seeds , prince of Siberia, eucalyptus, marsh cinquefoil, elecampane, juniper, linden color, sweet clover, hawthorn.
Persistent growth of neuroma - absolute reading for her surgical removal.
Radiation therapy consists of long-term irradiation of the head, which is especially effective in the presence of a small tumor. Used to treat the disease gamma knife, with which gamma rays are delivered directly to the tumor thanks to a stereoscopic X-ray navigation system. The procedure is carried out under local anesthesia V outpatient setting. The patient is placed on the couch after fixation of the stereotactic frame. During irradiation, the patient is talked to and observed. The tumor gets maximum dose radiation. This process is completely painless, fast, safe and quite effective compared to others therapeutic methods. The procedure provides excellent long-term clinical results.
In addition to the gamma knife, cyber-knife and linear accelerators are also used to treat schwannoma.
Surgical treatment consists of removing the acoustic neuroma. A week before surgery, patients are advised to stop taking anticoagulants and NSAIDs. For two days they are prescribed glucocorticosteroids and antibiotics. The choice of surgery is determined by the size and location of the tumor. The surgeon removes small neuromas as a single unit along with the capsule. Larger tumors are removed from the capsule, which is completely excised.
extraction of acoustic neuroma
Contraindications to surgical removal of acoustic schwannoma: old age, presence of concomitant pathology internal organs, unsatisfactory general condition sick.
Rehabilitation in a hospital lasts on average 5-7 days. The patient is in the department at this time. In the early postoperative period patients need to take medications that restore body functions and prevent tumor recurrence. Complete rehabilitation takes 6-12 months.
In rare cases, schwannoma may recur. In this case, the tumor grows in the same place. The reason for recurrence is incomplete removal of the neuroma the first time. Microscopic remains tumor cells lead to the development of a new pathological process.
Acoustic neuroma is a pathology that leads to the development of vital dysfunction important organs. To avoid the development of severe complications, it is necessary to promptly identify and treat the disease.
A little over a year ago, I began to notice that I heard worse what was happening to my right than what was happening to my left. I began to put the phone receiver to my left ear, and tried to turn my left side towards the interlocutor... I explained it to myself either as a cerumen plug, or as some kind of incomprehensible sluggish inflammation, which, as I expected, would go away on its own at the first opportunity. Nonsense, of course... Well, at least cut me... I don’t like going to clinics...
Almost six months passed like this. Last summer, this was supplemented by slight dizziness when turning the head from right to left, a feeling of numbness in the right side faces: as if the anesthesia had not yet worn off after visiting the dentist. Then I began to lose stability: I could suddenly be “led” in some direction, and returning to the starting position became quite problematic. And one day I woke up in the morning from a wild “helicopter” (I think there is no need to explain what it was), but since I was completely sober, I attributed this condition to the heat, smog and overwork. You will accuse me of being irresponsible towards my health, but could I have imagined that all these are links in one chain? And when symptoms are added one after another, you gradually get used to them and learn to live with it... In general, I only got to the ENT doctor at the end of autumn.
Then, quite quickly, a chain of ENT - audiogram - audiologist - MRI was built, according to the results of which it became clear that I had an acoustic neuroma (vestibular schwannoma, neuroma of the VIII cranial nerve, acoustic neuroma) - a benign, slow-growing tumor that is formed from cells included in the composition of the sheath of the VIIIth cranial nerve (also known as vestibulocochlear or auditory, consists of two portions responsible for hearing and vestibular apparatus). The reasons for the appearance of such tumors are unknown to science. There are only some hypotheses, but they are not confirmed by anything. In my case, it was already a fairly large tumor: almost 3.5 cm in diameter. Growing in a limited space of the skull, the tumor begins to compress the auditory, facial, trigeminal nerve, and in especially advanced cases, even the cerebellum and brain stem. Hence - dizziness and numbness of half the face. Well, as for hearing, everything is clear - first of all, it suffers. The incidence of acoustic neuromas is approximately 1 in 100,000 people per year.
Surprisingly, I had no panic or fear, which usually overcome people in such cases, at all. I saw this spot next to the brain on the picture, read the diagnosis and the first thought that flashed was: “How to get rid of this?” The all-knowing Internet offered two options: surgery or radiosurgery. The first option - craniotomy - was rejected by me immediately. With these words, I imagined terrible pictures like drilling or sawing bones, bald heads, holes in the skull and helpless patients who, due to inevitable complications, spend 2-3 months in the hospital and then for about another six months cannot recover from such a terrible operations.
Radiosurgery or gamma knife were much more attractive. Using a machine similar to an MRI, the tumor is exposed to dosed radio irradiation, after which the neuroma should stop growing, and perhaps, over time, shrink. The cost - about 250 thousand rubles - was a little confusing at first, but then I decided that no one had canceled the loans, and I was ready for financial exploits and getting financial help out of my employer, just to avoid the terrible trepanation and head shaving! There was a clause in the indications for radiosurgery - the tumor should be no more than 3 cm. “I’m almost there,” I decided, and with this thought I went to the neurosurgeon.
At the appointment, it turned out that the doctors had other plans for me. “What’s bad about it?” - I heard in response to a question about trepanation. “Get a quota. Where will you go for surgery - Moscow or St. Petersburg?” I, being in in a state of shock that my hopes for a bloodless solution to the problem were not justified, I chose the Research Institute of Neurosurgery named after. N. Burdenko. In general, with the wonderful prospect of craniotomy on the eve of my birthday and my mother’s anniversary, I celebrated the New Year.
It took a month to receive the quota. Hospitalization was scheduled for April 20. In the time that has passed since the diagnosis, I began to feel worse. Apparently, it was not without psychosomatics: when I turned my head to the left, my head began to spin so much that I could even fall. In the mornings, before getting up, I would “focus the image,” then get up and walk, staggering, as if I had been tasting champagne all night. The attacks with the “helicopter” brought me to the point of vomiting. The sensitivity of the right half of the face decreased even more, and the eyelid began to “twitch” more often. I don’t know if those around me noticed my uncertainty and unsteadiness when walking, but all this really bothered me...
And of course, during these 2 months that I still had to spend waiting for the operation, I searched the Internet for information about how trepanation is performed, what the head looks like after it (fontanel? titanium plates?), what is rehabilitation period and what complications threaten. As you understand, I didn’t find anything joyful for myself there. I read that the bones of the skull are completely removed, the wound is simply healed by muscles and skin, leaving a “fontanelle” similar to that of babies. And the worst thing of all possible complications After removing a large neuroma (more than 2 cm - it is already large), there was a possible paresis, or even paralysis of the facial nerve. This means that the face will become asymmetrical and, depending on the degree of damage to the nerve, it will lag behind when blinking or the eyes will not close at all, the corner of the mouth will not move or moves with a lag... Then it will be possible to do plastic surgery and transplant the hypoglossal nerve, but that will come later, after 3 months and it remains to be seen whether it will take root or not. Compared to this, the thought of having to shave my bald head no longer frightened me at all, and I knitted an openwork beret for the summer :) I was preparing to spend 2-3 months on sick leave.
I’ve been thinking for a long time that I want to be baptized, and after the surgeon’s words, “You have such a tumor, you might die after the operation,” this thought took root completely. I was baptized the day before leaving.
I wanted to write this part of the article - about how to fight - as dryly and strictly as possible, without details, just facts, but it didn’t work out. Some may not be interested in these details. Let me emphasize once again (I know it from my own experience): searching the Internet for first-hand information from survivors of surgical removal of a neuroma is almost useless. Those who communicate more often on forums serious complications after surgery - it’s terrible to read this before hospitalization! I want positive information, but there is none. That's why I write - so that it exists.
You can understand my emotions with which I went to Moscow to the Burdenko Research Institute only by experiencing something similar. There is complete uncertainty ahead, when you don’t know what your life will be like - the life of a young, interesting woman making plans - in 2 days, and whether it will happen at all (the neurosurgeon did not rule out such an outcome).
After long procedure hospitalization, I ended up in the 5th department, in my ward No. 6. The decor and atmosphere in the department seemed calm to me: quiet, cozy, clean, comfortable. Patients walk along the corridor, drink tea, watch TV, and communicate with their relatives. The heads are not bandaged, just some kind of bandage is glued to the area of the operation, and some without it at all. There are no bald people.
The next day - a conversation with the attending physician. Surgery tomorrow. I asked all the prepared questions and found out: if possible, they will try not to hurt the facial nerve (much depends on the location of the tumor), they will shave only the area behind the ear, they will put the skull bones in place and make a neat stitch, since I am young and pretty . In the evening I signed a paper that I was warned about the risk of surgical intervention up to the most extreme circumstances and measures. The last meal is lunch, despite the fact that the operation is scheduled for 5 pm the next day.
At 8 am I find out that everything has changed and I have to go. Urgent call to my husband. Everything is so fast that there is no time to even be afraid. The nurse brings anti-embolic stockings, I lie down on the gurney and we go. On the clock in the corridor 09:04, in my head - “My angel, walk with me, you are ahead, I am behind you” and the Lord’s Prayer... Operating room, anesthesiologist, IV, “now you...”, yes, I already feel like I’m falling through ...
I woke up in intensive care. After the operation, the patient must be transferred to intensive care. And as soon as you are sure that everything is fine, go to the ward. I was there from 2 pm on the day of surgery until 10 am the next day. The first thing I did when I came to my senses was to check if everything was okay with my face. She opened her eyes. I tried to smile. It worked! Hooray! The facial nerve is intact! Coming out of anesthesia was not easy. But the first breakfast literally brought me back to life (I hadn’t eaten for almost two days!)
I spent the first day after resuscitation in bed, then the doctor allowed me to sit up, then get up and walk. Patients have the opportunity to use the services of nannies (for a fee): they help with absolutely everything - eating, toileting, hygiene, bringing something, handing you something, getting up, walking with you along the corridor, etc.
So the days of recovery and, fortunately, recovery dragged on. In the first days I was still dizzy, my throat was sore from the breathing tubes, my voice was nasal, my facial muscles were weak, my head in the area of the operation was numb and I didn’t feel anything, I could only sleep on my left side, but every day I still felt better and better.
I was discharged exactly a week after the operation. My neurosurgeon Vadim Nikolaevich Shimansky said that I need to continue to live the same way as I lived: there are no contraindications, the most important thing is not to abuse anything (not a bath, not a tan, or anything at all). Everything in moderation, in fact, as for everyone healthy people. The tumor was not easy, it was not possible to remove it 100%, it was already dangerous. Therefore, after 3 months - a control image and in the absence of growth dynamics, the next image - a year later. Well, with growth - that same Gamma Knife.
A little over a month has passed since I returned home. I’m still on sick leave, but I work on the radio, and I couldn’t resist trying to go on air. Who would have thought that I could do this 2 weeks after craniotomy!!! Now I feel much better than before the operation - the terrible dizziness has gone, the sensitivity of my face has been restored, and the numbness in my head is gradually disappearing. But most likely it will not be possible to restore hearing on the right side - the auditory nerve was too damaged by the tumor. But you can live with it, I’m already used to it.
But now I understand that what seems to us to be our weakness, our vulnerable side, can easily become our advantage, and that’s exactly what happened to me. The size of the tumor, which local surgeons did not undertake to operate on, allowed me to fall into the hands of excellent specialists with golden hands - the head of the 5th department of the Neurosurgery Research Institute named after. N.I. Burdenko, Doctor of Medical Sciences Vadim Nikolaevich Shimansky and attending physician Vladimir Kirillovich Poshataev. Thank you, dears!
The story of my illness is not yet complete, but the worst is behind me. I was lucky, I got off with a slight fright compared to what could have happened. Unfortunately, not all operations lead to the same result; I know other stories. But in spite of everything, I wish everyone who is faced with a similar problem optimism, hope and faith in the best. Even if it’s very scary, you need to move forward and not doubt those in whose hands your health and life are. Be healthy!
P.S. Upon returning home, I left reviews about the Burdenko Research Institute with my coordinates on many sites. In a month I managed to support and inform about 10 people about the operation. I will be happy to answer your questions if any arise.
Acoustic neuroma is a neoplasm benign in nature, It has been established that the tumor originates from Schwann cells of the eighth pair of cranial nerves. This pathology may also have other names, such as acoustic neuroma, neurilemmoma, schwannoma, etc. In most patients, the tumor of the auditory nerve grows slowly or does not grow at all. But in some cases, rapid progression and development of the tumor is possible, which can lead to compression of the structural elements of the brain and drastic violation vital activity of the body. Without indicating the exact location, the diagnosis is sometimes formulated as cerebral neuroma.
To date, the exact cause of acoustic neuroma has not been established. Nevertheless, many scientists express a well-founded opinion that the appearance of a tumor on the eighth pair of cranial nerves is most likely associated with a defective gene on the 22nd chromosome. Under normal conditions, this gene produces a special protein responsible for controlling the development of Schwann cells that cover nerve fibers. However, why the defective gene appears is currently unknown.
It has been scientifically established that the defective gene is present in patients suffering from neurofibromatosis type 2. These patients have a typical clinical picture of the disease, distinguishing them from other patients.
Some epidemiological and statistical data on benign neoplasms:
Schwann cells are considered accessory elements nerve tissue, which perform a supporting and trophic function for the axon of the peripheral nerve fiber.
The main risk factor for acoustic neuroma is having one parent with a genetic pathology called neurofibromatosis type 2. However, this single known factor can explain very few cases of the disease. The leading sign of type 2 nephrofibromatosis is the occurrence benign tumors in the central nervous system and peripheral nerves. It is a typical autosomal dominant disease. It follows that the mutation can only be passed on from the mother or father who has the dominant gene. If a child has a mother or father with neurofibromatosis type 2, his or her chances of inheriting the disease are 50/50.
Exposure to low dose radiation on the head and neck area childhood should also be considered as a possible risk factor for acoustic neuroma.
The direct impact of the neoplasm on the eighth pair of cranial nerves or compression of nearby structural elements of the central nervous system provokes the development clinical symptoms Acoustic neuromas. As a rule, it all starts with hearing loss. At the initial stage, hearing loss is often the only sign of the disease. In addition, there is the appearance of various noises and sounds in the ear on the affected side. Sometimes such problems do not bother the patient. Some patients may not notice hearing loss for quite a long time.
Dizziness appears and progresses gradually. Vestibular crises are possible, in which the patient becomes severely nauseous and vomits. An objective examination reveals horizontal nystagmus (when eye movements are involuntary and oscillatory). After some time, numbness, a tingling sensation and soreness appear in the part of the face on the side of which the tumor is located. Pain from acoustic neuroma is usually aching and dull. At the beginning of the disease they periodically intensify and subside. The appearance of pain is associated with the fact that the tumor begins to compress the trigeminal nerve, which passes directly next to the auditory nerve. With increasing compression of the trigeminal nerve, the pain syndrome becomes constant.
If the tumor continues to grow in size, damage to other cranial nerves (facial and abducens nerves) is inevitable. The patient notes a noticeable weakening of the facial muscles, loss of taste and impaired salivation. If the abducens nerve is affected, diplopia (double vision) occurs. At first, this clinical symptom periodically appears and disappears, but later becomes permanent.
Late signs of the disease include the occurrence of increased intracranial pressure. As a result, damage to the optic nerve occurs due to stagnation of its elements. Changes in visual fields are recorded according to various types. In addition, the patient suffers from constant headaches, located mainly in the forehead and back of the head. Vomiting of central origin is often observed.
The main symptoms of acoustic neuroma:
In accordance with generally accepted clinical practice There are several stages of development of acoustic neuroma. Let's look at each of them in some detail:
Due to the small size and lack of tumor growth, some patients do not show clinical symptoms of acoustic neuroma and, as a rule, no treatment is undertaken. In such cases, regular monitoring by a doctor is indicated.
Based on clinical symptoms alone, it is quite difficult to determine acoustic schwannoma at any stage of development, even for a highly qualified and experienced physician. Diagnosis of acoustic neuroma may consist of following methods research:
Audiometry can measure hearing acuity and diagnose the onset of hearing loss. Bone and air conduction of sound is also assessed, which makes it possible to identify the features and nature of hearing impairment. Regular audiometry will determine the presence or absence of progression of hearing impairment.
As shown clinical practice, schwannomas measuring less than one centimeter are quite difficult to detect on a CT scanner. On initial stage basic diagnostic methods the use of otoneurological examination is considered x-ray examination temporal bones. The radiological sign of acoustic schwannoma is the identification of enlargement of the internal auditory canal. Almost 40% of tumors, the size of which is up to 2 cm, cannot be detected on a conventional computed tomograph without the use of contrast. Today, quite often, when diagnosing acoustic neuroma, they resort to magnetic resonance imaging (MRI), which is considered one of the most informative and safe methods.
Modern and innovative examination methods significantly simplify the diagnosis of both malignant and benign neoplasms of the central and peripheral nervous system.
According to clinical experience, treatment of acoustic neuroma may vary depending on the size and growth trend of the tumor, as well as the appearance of new clinical symptoms. The main treatment tactics for acoustic neuroma that your doctor can suggest:
If you have been diagnosed with a small acoustic neuroma that is not growing or is growing very slowly in size and does not provoke a serious clinical picture, then your doctor may recommend not treating the tumor at this stage, but actively monitoring it. To do this, you will be asked to undergo regular clinical examination (computed tomography, MRI, audiometry, etc.) every 6–12 months to monitor the growth and spread of the tumor. What other indications for monitoring can be identified:
In some cases, without surgical intervention can't get by. Can be used various techniques for surgical removal of acoustic neuroma. The purpose of the operation is not only complete removal tumors, but, if possible, preserving the function of the facial nerve and hearing in the patient. Surgical intervention is performed under general anesthesia using various operational access(for example, through the inner ear). Any surgery to remove an acoustic schwannoma carries the risk of hearing loss or injury to the facial nerve. What are the indications for surgical treatment:
The optimal choice of treatment for acoustic neuroma is determined by the attending physician, taking into account the clinical picture of the disease, tumor growth, progression of symptoms, the presence of concomitant pathology and the patient’s condition.
For small tumors, radiation therapy stops growth in almost 95% of cases. Single irradiation of acoustic neuroma with high doses of ionizing radiation is used. Currently, this procedure is called stereotactic radiosurgery. It is scientifically proven that the effects of radiation therapy can take months, or even years, to begin to appear. At the same time, clinical trials showed that many patients who underwent stereotactic radiosurgery gradually lost their hearing over 10 years. Indications for this type of procedure:
Treatment of acoustic neuroma without surgery is possible if there are indications for radiation therapy.
Timely detection of acoustic schwannoma in the initial stages of the disease allows effective treatment and count on a favorable prognosis without significant consequences. In such cases, patients, as a rule, fully recover and remain functional.
refers to benign neurogenic tumors of the cerebellopontine angle with unfavorable clinical course. It comes from the cells of the Schwann membrane of the vestibular portion of the VIII nerve from the bottom of the internal auditory canal to the entrance to the medulla oblongata.
It is more common in people aged 30-60 years. It accounts for 6% of all intracranial tumors and 35% of tumors of the posterior cranial fossa. In 2-3% of cases, neuroma is bilateral. It grows slowly.
There are three stages of the disease.
The first stage of development is otiatric (tumor up to 1.5 cm) is characterized by cochleo-vestibular symptoms: constant noise in the ear, sensorineural hearing loss, tone-speech dissociation (speech intelligibility is impaired with relative preservation of tonal hearing), occasionally ear pain or headache, mild impairments static balance, some uncertainty in gait, dizziness.
The tuning experiments of Rinne and Federici are positive. The tone audiogram has a horizontal and then descending character, mainly in the area high frequencies, with the absence of air-bone interval. There is an increase in the level of auditory discomfort and a lack of lateralization of sounds in the audible range in Weber’s experiment in the presence of lateralization of ultrasounds into the healthy ear. FUNG is not detected, the reverse adaptation time increases to 15 minutes, its threshold is shifted to 30-40 dB (normally 0-15 dB). Impedance measurements show a decay of the acoustic reflex of the stapes. Normally, within 10 s the amplitude of the reflex remains constant or decreases to 50%. A reflex half-life of 1.5 s is considered pathognomonic for neuroma of the VIII nerve. The stapes reflex (ipsilateral and contralateral) may not be evoked when the affected side is stimulated. Otoacoustic emissions (OAE) are not recorded on the affected side. During audiometry using auditory evoked potentials, the interpeak interval of I and V ACEP is prolonged. At large tumors KSVP is not called.
Patients have difficulty understanding words during telephone conversation, severe hearing fatigue is noted. 75% of patients have chronic disorder static balance with instability when walking, horizontal spontaneous nystagmus in the healthy direction. With caloric and rotational tests, pronounced asymmetry of nystagmus is often observed.
X-rays of the temporal bones according to Stenvers may show expansion of the internal auditory canal. Computer and magnetic resonance imaging scans reveal a tumor of the YIII nerve. Magnetic resonance imaging has greater resolution in the diagnosis of neuroma, especially in combination with the introduction of contrast agents that increase the information content of the image (Fig. 1.13.1).
The second stage - otoneurological (tumor from 1.5 to 4 cm) is characterized by headache, increased hearing loss, statokinetic disorders, unilateral cerebellar symptoms, absence of caloric nystagmus on the affected side, dysfunction of the trigeminal nerve (paresthesia, decreased or absent corneal reflex), paresis abducens nerve (convergent strabismus and diplopia). There is an increase in the thresholds of the acoustic reflex and its accelerated decay. Large-scale spontaneous nystagmus appears in the direction of the diseased ear (cerebellar). When the facial nerve is damaged in the internal auditory canal, peripheral paresis of the facial muscles, suppression of lacrimation and salivation are observed. Due to compression of the n.intermedius (XIII pair), which goes along with the facial nerve, taste sensitivity to sweet and salty on the anterior two-thirds of the tongue is disrupted. There is a headache in the back of the head (initial symptoms of intracranial hypertension). At this stage, destruction of the internal auditory canal and protein-cell dissociation in the cerebrospinal fluid occurs.
The third stage - neurosurgical (tumor from 4 to 6 cm or more) is manifested by severe hearing loss, up to deafness, loss of vestibular function. Symptoms of damage to the cerebellum, pyramidal system and severe intracranial hypertension(congestive nipples optic nerves, severe headache, nausea, vomiting, etc.). Along with damage to the facial, intermediate and abducens nerves, dysfunction of the trigeminal and abducens nerves in the cerebellopontine angle is more often observed. Subsequently, bulbar disorders develop, damage to many cranial nerves, including visual impairment up to blindness, gaze paralysis, swallowing disorder, phonation, and decreased sense of smell. Severe hydrocephalus develops. The statokinetic function is disturbed according to the central type with dissociation and disharmonization of reactions.
For otiatrists, the first two stages of neuroma are of particular interest, when timely diagnosis And surgical treatment further spread of the tumor can be prevented. At primary diagnosis unilateral sensorineural hearing loss, it is necessary to exclude neuroma using the most modern methods diagnostics
Differentiate neuroma with Meniere's disease, arachnoiditis of the cerebellopontine triangle and hearing loss of various origins with an intact eardrum.
Treatment is surgical. The most favorable outcomes are for tumor stages I and II. Neurosurgical approaches to neurinoma are carried out through the posterior and middle cranial fossa, and the otiatric approach is transpyramidal through the mastoid process, temporal bone to the internal auditory canal. The otiatric method is more gentle (Gorokhov A.A., 1989).
Patients with benign and malignant tumors ear are immediately sent to the hospital. After treatment, they are under the dynamic supervision of a unit doctor. A follow-up examination by an otolaryngologist is carried out at least once every 6 months. When testifying, military personnel are examined under articles 8,9,10 of Order of the Ministry of Defense of the Russian Federation No. 315 of 1995.
The most common neoplasm of the cerebellopontine angle is neuroma of the VIII nerve. In most cases it is benign. As a rule, it affects able-bodied people aged 20 to 60 years, with women twice as likely.
The traditional location of neuroma is the terminal part of the VIII nerve. Its further growth is possible towards the internal auditory canal or the cerebellopontine angle. Depending on the direction of growth and size of the tumor, compression can extend to the cerebellum, pons, V and VII pairs of cranial nerves, and bulbar cranial nerves. The growth rate, as a rule, does not exceed 2–10 mm per year.
Surgery is used to treat neuroma of the VIII nerve. The specific method of tumor removal is determined by its size, anatomical and topographical features of localization, intensity of vascularization, and characteristics of the capsule.
The incidence of complications after surgery depends on the size of the tumor. Thus, the function of the facial nerve can be preserved:
If the size of the tumor exceeds 3 cm, then the risk is significantly higher.
In case of subtotal resection of neuroma of the VIII nerve, in some cases radiation therapy can be performed, but there is no reliable data on its positive impact there is no impact on the further course of the disease.
Considering slow growth tumors, in some situations (especially in elderly people or patients with severe comorbid background) it will be justified conservative treatment. It involves monitoring the patient's condition with CT or MRI to evaluate clinical situation in dynamics. Concomitant hydrocephalus is eliminated by shunting, which in this case acts as a palliative treatment for neuroma of the VIII nerve.
Patient E., 28 years old. Complaints of double vision, unsteadiness, headache, lack of hearing left ear, numbness of the left half of the face, dryness of the left eye, impaired facial expressions of the left half of the face
The examination revealed a tumor in the left place-cerebellar angle.
Neuroma of the VIII nerve 
the tumor spreads into the internal ear canal
An operation was performed - removal of the innocent VIII nerve using intraoperative electrophysiological monitoring of the causal group of nerves. During the operation, the location of the facial nerve fibers was identified. In view of high risk it was decided to leave them damaged and the insignificant volume of the tumor and recommend a consultation with radiologists in the postoperative period to resolve the issue of radiation treatment.
