From the Guidelines
The treatment approach for vertigo due to acoustic neuroma should prioritize a multidisciplinary assessment considering tumor size, growth rate, symptom severity, and patient factors, with a focus on improving morbidity, mortality, and quality of life outcomes. According to the most recent and highest quality study 1, the management of sporadic intracanalicular vestibular schwannomas is controversial, with no current international multidisciplinary consensus guidelines. However, the study suggests that upfront stereotactic radiosurgery (SRS) is an effective treatment in achieving tumor control with similar rates of hearing preservation, and conservative surveillance (CS) should be considered as the recommended approach for older patients and no appreciable tumor growth regardless of hearing status.
Key Considerations
- Tumor size and growth rate: smaller, slow-growing tumors may be managed with observation and regular MRI monitoring every 6-12 months 1
- Symptom severity: patients with mild vertigo may be managed with vestibular rehabilitation therapy and symptomatic medications such as meclizine, diazepam, or promethazine 1
- Patient factors: age, comorbidities, hearing status, and overall health status should be considered when deciding between observation, surgery, or radiation 1
- Treatment options: surgical resection via translabyrinthine, retrosigmoid, or middle fossa approaches, or stereotactic radiosurgery (Gamma Knife) delivering 12-13 Gy to the tumor margin in a single session 1
Treatment Approach
- For small, slow-growing tumors causing mild vertigo, observation with regular MRI monitoring and vestibular rehabilitation therapy is recommended 1
- For larger tumors or those causing significant symptoms, definitive treatment with surgical resection or stereotactic radiosurgery should be considered 1
- For older patients and no appreciable tumor growth regardless of hearing status, conservative surveillance is recommended 1
Symptomatic Management
- Medications such as meclizine, diazepam, or promethazine can provide temporary relief for vertigo symptoms 1
- Vestibular rehabilitation therapy can help the brain compensate for balance disturbances 1
From the FDA Drug Label
Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults. Recommended dosage: 25 mg to 100 mg daily, in divided doses.
The treatment approach for a patient with vertigo due to an acoustic neuroma may involve the use of meclizine. The recommended dosage is 25 mg to 100 mg daily, in divided doses.
- Key considerations:
- May cause drowsiness
- Potential anticholinergic action
- Coadministration with other CNS depressants may result in increased CNS depression 2
From the Research
Treatment Approach for Acoustic Neuroma with Vertigo
The treatment approach for a patient with vertigo due to an acoustic neuroma involves various methods to manage the condition.
- Preoperative assessment is crucial in determining the operative approach and postoperative rehabilitation 3.
- Surgery is a common treatment option, but it can result in postoperative vertigo, which can be debilitating 4.
- Compensation for impaired equilibrium can be achieved through biofeedback in the vestibular pathways, visual control, exercise, or drug therapy 4.
- Nurses play a significant role in the recovery of acoustic neuroma patients by encouraging and reinforcing exercise and other mechanisms of vestibular compensation 4.
- There is currently no approved pharmacotherapy for vestibular schwannomas (acoustic neuromas), but molecular targeted inhibitors have shown therapeutic effects in preclinical experiments or clinical trials 5.
Diagnostic Tests
Diagnostic tests such as hyperventilation can be used to provoke an ipsilateral beating nystagmus and reproduce the vertiginous sensation in patients with acoustic neuroma 6.
- Dynamic posturography can be used to evaluate patients with acoustic neuroma and determine the location of the tumor on the vestibular nerve 7.
Management of Vertigo
Management of vertigo in patients with acoustic neuroma is crucial to improve their quality of life.