Acoustic neuroma differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

Acoustic neuroma must be differentiated from meningioma, intracranial epidermoid cyst, facial nerve schwannoma, trigeminal schwannoma, ependymoma, leiomyoma, intranodal palisaded myofibroblastoma, malignant peripheral nerve sheath tumour (MPNST), gastrointestinal stromal tumor, neurofibroma, Meniere's disease, and Bell's palsy.[1]

Differential Diagnosis

Acoustic neuroma must be differentiated from:[2]

Differentiating features of common differential diagnosis are:[1]

Disease/Condition Differentiating Signs/Symptoms Findings on CT or MRI
Meningioma
  • Hearing loss is less common
  • Usually more homogeneous in appearance: significant signal heterogeneity with cystic or haemorrhagic areas is more typical of vestibular schwannoma than meningiomas (although cystic meningiomas do occur)
  • Meningiomas tend to have a broad dural base
  • Usually lack trumpet IAM sign
  • Calcification is more common
Intracranial epidermoid cyst
  • Hearing loss is less common
  • No enhancing component
  • Very high signal on DWI (Diffusion weighted imaging)
  • Does not widen the IAC (Internal auditory canal)
Facial nerve schwannoma
  • Facial weakness is common and occurs early
  • Sometimes associated with neurofibromatosis
  • CT and MRI imaging results are similar to acoustic neuroma but enhancement extends into the geniculate ganglion of the facial nerve and facial canal
Trigeminal schwannoma
  • Clinically associated with facial numbness
  • Hearing loss is less common
  • CT and MRI imaging displays a dumbbell-shaped mass over the petrous apex affecting Meckel cave.
  • The trigeminal nerve enhancement extends proximal to the tumor and does not extend into the IAM (internal acoustic meatus)

References

  1. 1.0 1.1 Acoustic Schwannoma. Radiopedia(2015) http://radiopaedia.org/articles/acoustic-schwannoma Accessed on October 2 2015
  2. Schwannoma. Librepathology(2015) http://librepathology.org/wiki/index.php/Schwannoma Accessed on October 2 2015
  3. Chan PT, Tripathi S, Low SE, Robinson LQ (2007). "Case report--ancient schwannoma of the scrotum.". BMC Urol. 7: 1. PMC 1783662Freely accessible. PMID 17244372. doi:10.1186/1471-2490-7-1. 

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