Gamma Knife of Spokane, 910 W 5th Ave, Suite 102, Spokane, WA 99204, USA.
World J Surg Oncol. 2009 Dec 18;7:100. doi: 10.1186/1477-7819-7-100.
Vestibular schwannomas, also called acoustic neuromas, are benign tumors of the vestibulocochlear nerve. Patients with these tumours almost always present with signs of hearing loss, and many also experience tinnitus, vertigo, and equilibrium problems. Following diagnosis with contrast enhanced MRI, patients may choose to observe the tumour with subsequent scans or seek active treatment in the form of microsurgery, radiosurgery, or radiotherapy. Unfortunately, definitive guidelines for treating vestibular schwannomas are lacking, because of insufficient evidence comparing the outcomes of therapeutic modalities.We present a contemporary case report, describing the finding of a vestibular schwannoma in a patient who presented with dizziness and a "clicking" sensation in the ear, but no hearing deficit. Audible clicking is a symptom that, to our knowledge, has not been associated with vestibular schwannoma in the literature. We discuss the diagnosis and patient's decision-making process, which led to treatment with Gamma Knife radiosurgery. Treatment resulted in an excellent radiographic response and complete hearing preservation. This case highlights an atypical presentation of vestibular schwannoma, associated with audible "clicks" and normal hearing. We also provide a concise review of the available literature on modern vestibular schwannoma treatment, which may be useful in guiding treatment decisions.
前庭神经鞘瘤，也称为听神经瘤，是前庭耳蜗神经的良性肿瘤。这些肿瘤的患者几乎总是表现出听力损失的迹象，许多患者还会出现耳鸣、眩晕和平衡问题。在进行对比增强 MRI 诊断后，患者可能会选择通过后续扫描观察肿瘤，或选择接受显微手术、放射外科或放疗等积极治疗。不幸的是，由于缺乏比较治疗方式结果的充分证据，因此缺乏治疗前庭神经鞘瘤的明确指南。我们报告了一个当代病例，描述了一位患者因头晕和耳部“咔嗒”声就诊，而无听力损失，发现前庭神经鞘瘤的情况。可闻性咔嗒声是一种症状，据我们所知，在文献中尚未与前庭神经鞘瘤相关。我们讨论了诊断和患者的决策过程，最终选择接受伽玛刀放射外科治疗。治疗后获得了极好的影像学反应和完全的听力保留。该病例突出了前庭神经鞘瘤的一种非典型表现，伴有可闻性“咔嗒”声和正常听力。我们还对现代前庭神经鞘瘤治疗的现有文献进行了简洁的回顾，这可能有助于指导治疗决策。
