CN VIII has two distinct functional divisions: the cochlear nerve for hearing and the vestibular nerve for balance. Vestibular schwannoma (acoustic neuroma), the most common cerebellopontine angle tumour, arises from the superior vestibular nerve's Schwann cells and presents with unilateral sensorineural hearing loss, tinnitus, and disequilibrium. MRI with gadolinium is diagnostic, the tumour enhances within the internal auditory canal.
| Origin | Vestibulocochlear nucleus complex in the lateral pontomedullary junction |
|---|---|
| Course | Travels with CN VII through the internal auditory meatus of the petrous temporal bone. The two nerves are closely associated throughout their intracranial and intrameatal course |
| Motor |
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| Sensory |
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Vestibular schwannoma management options depend on size and growth: observation (small tumours <2 cm with slow growth), radiosurgery (Gamma Knife for 2-3 cm), or microsurgery (retrosigmoid or translabyrinthine approach for larger tumours). Cochlear nerve preservation during surgery maintains residual hearing. Facial nerve monitoring is mandatory during surgical resection.
Acoustic nerve tumour producing unilateral SNHL and tinnitus managed with surveillance, Gamma Knife, or microsurgery depending on size.
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