Sporadic vestibular schwannoma: correlation between tumour size, hearing levels, age and radiologic features in 384 patients

Objective: The aim of this study was to delineate characteristics of patients diagnosed with unilateral sporadic vestibular schwannoma. Symptomatology and MR imaging were correlated to hearing levels, tumour size, age, and radiologic features. Methods: Retrospective study in a tertiary referral centre for neurotology and skull base surgery on 384 patients with a unilateral sporadic vestibular schwannoma in the cerebellopontine angle. Patients with intralabyrinthine schwannoma, neurofibromatosis type 2, meningiomas, and patients already treated elsewhere, were excluded from analyses. Results: Age ranged from 11 to 92 years (mean age of 52 years). At presentation, 75% complained of ipsilateral subjective hearing loss, 56% of tinnitus, 41% of vertigo, 19% of ear fullness. A cystic component was observed in 21%, brainstem compression in 33%. Tumour size included 31% intracanalicular, 20% small, 28% medium, 13% moderately large, 6% large and 2% giant tumours. A weak positive correlation between tumour size and hearing loss was observed. We also noticed a weak negative correlation between age and tumour size. Conclusion: Our series confirms subjective hearing loss being the main presenting complaint of sporadic vestibular schwannoma at any age. Nevertheless, more than half of our cases presented initially with tinnitus. This emphasizes the importance of imaging for tinnitus and hearing loss in patients. Although all sizes of tumour can present with all types of hearing loss, there is a weak positive correlation between size and hearing loss. Furthermore, we observed a significant negative correlation between age and tumour size. The presence of cystic components is associated with larger tumour size but not with hearing loss.