Acoustic neuroma staging

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Acoustic neuroma staging have been reported in several articles. Standardization of main symptoms grading is another important staging for description of patients' status.


Standardization of main symptoms grading 

For better description of patients' status then analyzing management strategy and outcome of the treatment, standardized grading for main symptoms have been made. Generally, the AAO-HNS Hearing Classification System, House-Brackmann Facial Nerve Grading System, Tinnitus Handicap Inventory and Dizziness Handicap Inventory are widely accepted and used for Acoustic neuroma.

Tinnitus grading system for acoustic neuromas
Grade Description


No tinnitus


Intermittent or mild tinnitus, can only be heard when the ambient noise is low


Persistent or moderate tinnitus, can be heard every day


Persistent and severe tinnitus, interfere with work and sleep
Dizziness grading system for acoustic neuromas
Grade Description


No dizziness or imbalance


Occasional and mild dizziness or imbalance


Persistent or moderate vertigo or imbalance


Persistent and severe dizziness or imbalance, disturbing daily life

Tumor size and stages 

Numerous stage grading system ave been reported according to tumor size, but also for the first step description of the tumor size is more important and have measured by the maximum diameter (means the one measured in cerebellopontine angle (CPA) along the long axis) of the tumor.[1][2][3]

Main grading systems for acoustic neuromas
Tumor size (CPA Maximum diameter) Sterker House Koos Samii Tumor Description


Tube type intracanalicular Grade I T1 Confining to IAC
≤10 mm Small Grade 1


Grade II T2 Superpassing IAC
≤15 mm Grade 2


T3a Tumor occupying CPA
≤20 mm Mild
≤3o mm Grade 3

(Moderately Large)

Grade III T3b Tumor occupying CPA and contacting

the brainstem without compression

≤40 mm Large Grade 4


Grade IV T4a Tumor compressing the brainstem
>40 mm Huge Grade 5


T4b Sever brainstem displacement and deformation of fourth ventricle under tumor compression
Main grading systems for acoustic neuromas. The classifications on the left side (blue area) are mainly based on tumor size, while those on the right side (yellow area) are based on the anatomical relationship around the tumor. Koos classification (green area) combines the tumor size and anatomical relationship for larger tumors. IAC: Intracoustic canal



  1. Sterkers JM, Morrison GA, Sterkers O, El-Dine MM., JM (1994). "Preservation of facial, cochlear, and other nerve functions in acoustic neuroma treatment.". Otolaryngol Head Neck Surg. 
  2. Hitselberger WE, House WF (1966). "classification of acoustic neuromas". Arch Otolaryngol. 
  3. Koos WT, Day JD, Matula C, Levy DI. "Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas". J Neurisurg. 
  4. Hao Wu, Liwei Zhang, Dongyi Han, Ying Mao, Jun Yang, Zhaoyan Wang, Wang Jia, Ping Zhong, Huan Jia (2016). "Summary and consensus in 7th International Conference on acoustic neuroma: An update for the management of sporadic acoustic neuromas". World Journal of Otorhinolaryngology-Head and Neck Surgery.