Vestibular schwannoma

Vestibular schwannomas (commonly referred to by the misnomer acoustic neuroma) are benign, slow-growing tumours arising from the Schwann cells on the sheath of the vestibulocochlear nerve. Vestibular schwannomas are the third most common benign intracranial tumour after meningioma and pituitary adenoma and are the most common tumour of the cerebellopontine angle. Vestibular schwannomas can present and grow in unpredictable ways. There is a lack of high-level evidence on appropriate management, and as such, this can vary significantly between centres. With the ease of access to sensitive neurological imaging, vestibular schwannomas are identified in more patients, at more advanced ages, and at smaller sizes, with a shift in the management towards a more conservative approach over previous decades. This article summarises the epidemiology, aetiology, clinical features, investigation, management and prognosis of vestibular schwannoma.