Development and Risks
Growth Rate
Only 40% of schwannomas increase in size after their discovery. When they do grow, it is usually at a slow rate of 1 to 2 mm per year, sometimes faster. A period of observation is therefore often proposed first.Tumor-Related Risks
These tumors are not cancerous and do not spread. However, if they grow, they can compress the cerebellum, brainstem, and adjacent nerves — potentially leading to severe disorders, or even hydrocephalus (dilation of the cerebral ventricles).Diagnosis
As symptoms resemble those of other ear conditions, diagnosis can be challenging. It relies on several complementary examinations:
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Hearing Test (Audiometry)
First examination performed. It measures how the patient perceives sounds and speech, via headphones connected to a device that records auditory function.
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Auditory Evoked Potentials (AEP)
Measure the conduction speed of electrical impulses along the acoustic nerve, from the inner ear to the brain. Electrodes placed on the scalp capture the brain's response to sounds.
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Brain MRI
The reference examination to confirm the diagnosis and specify the tumor's location, size, and relationship with neighboring structures.
Therapeutic options
There are three main approaches. The choice is discussed during a Multidisciplinary Consultation Meeting (MCM Neuroma) bringing together neurosurgeons, ENT surgeons, hearing and vertigo specialists, radiation oncologists, and radiologists.
- Observation Preferred for small tumors. No side effects, but requires regular MRI follow-up to ensure stability. Active treatment is recommended if the tumor grows or if symptoms become bothersome.
- Surgery Reserved for large tumors or when radiotherapy is not feasible. A delicate procedure due to the proximity of the facial nerve. Our team's philosophy is to preserve facial nerve function, even if it means leaving a tumor residue (in 30% to 40% of cases). If this residue progresses, complementary radiosurgery is proposed.
- Radiosurgery The reference treatment for small and medium-sized tumors. Delivers a high dose of radiation in 1 to 3 fractions, with very high ballistic precision. It does not remove the tumor but stops its progression in the majority of cases. In approximately 5% of cases, the tumor continues to grow despite treatment. In over 30% of cases, transient pseudo-progression is observed before stabilization or regression.
ZAP-X — Advanced Radiosurgery
Our department is equipped with the ZAP-X, a latest-generation radiosurgery device that allows for the treatment of vestibular schwannomas with optimal precision and safety. Multiple beams converge on the target: each beam individually delivers a low dose, but their convergence generates a high, localized dose on the lesion, preserving adjacent tissues.
Multidisciplinary Meeting (MCM Neuroma)
All involved teams meet once a month to discuss cases and define the best strategy for each patient: surgery, radiotherapy, or observation.
In 2022, Prof. Sébastien Froelich participated in drafting the EANS recommendations for the management of vestibular schwannomas.
These tumors are caused by damage to the genetic material of the cells that form the sheaths of the balance nerves. The reason why this genetic material is damaged is unknown. No risk factors have been identified.
Acoustic neuromas are very rare. Every year, one acoustic neuroma is diagnosed for every 100,000 inhabitants. They can occur at any age, but are most often identified between the ages of 40 and 60.
The most common symptom is hearing loss. Some people may lose their hearing completely, and sometimes suddenly, but most simply notice a gradual deterioration over time.
Some patients may hear noises or whistling in the ear, known as tinnitus. It can be quite annoying, but there are a number of effective treatments that can help.
Many patients experience occasional or persistent imbalance.
Other symptoms may include numbness of the face, pain in the bone behind the ear, headaches or facial spasms known as "facial tic". Facial muscle weakness (facial paralysis and facial asymmetry) is unusual.
Guide
Your stay is our priority, and we have established a patient pathway program for your surgical schedule, admission and intervention, through to your discharge. Please do not hesitate to contact us if you have any questions.