Management of intralabyrinthine schwannomas

Our protocol to manage the intralabyrinthine schwannoma (ILS).

Retrospective chart review of 7 consecutive patients managed for ILS.

Five patients underwent surgical removal of the lesions and none experienced significant complications or recurrent disease. One patient refused surgical treatment and was closely followed by serial MRI scans with no signs of tumor growth. One patient is presently managed conservatively due to a good hearing.

Diagnosis of ILS is based on high resolution MRI scans and should be included in the differential diagnosis of patients investigated for cochleovestibular symptoms. Treatment modality of ILS is controversial and depends patients' age, severity of vertigo and hearing loss. In the authors' experience surgery is indicated in all cases with invalidating vertigo and in the young patients with severe hearing loss. Conservative strategy is advised in older patients and in cases with preserved good hearing and no invalidating vertigo. These patients must be followed up using high resolution MRI because of the risk of tumor growth into the internal auditory canal. While tumors with exclusive involvement of the inner ear may be removed by means of a completely extradural approach, tumor growth with involvement of the internal auditory canal dictates the necessity of opening the dura exposing the patients to the potential risks associated with the procedure.