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| __FORCETOC__
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| {{Acoustic neuroma}}
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| {{CMG}}
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| ==Overview==
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| Acoustic neuroma staging have been reported in several articles. Standardization of main symptoms grading is another important staging for description of patients' status.
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| ==Staging==
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| === Standardization of main symptoms grading ===
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| 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 Classifi- cation System,6 House-Brackmann Facial Nerve Grading System,7 Tinnitus Handicap Inventory8 and Dizziness Handicap Inventory9 are widely accepted and used for Acoustic neuroma.
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| {| style="border: 3px; font-size; 190%; margin: 1px; width: 600px" align="center"
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| ! colspan="2" style="background: #5579FF; width: 600px:" | {{fontcolor|#FFF|Tinnitus grading system for acoustic neuromas}}
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| |-
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| ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Grade}}
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| ! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Description}}
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| |-
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| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |
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| I
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| | style="padding: 10px 10px; background: #F5F5F5; " | No tinnitus
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| |-
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| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |
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| II
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| | style="padding: 10px 10px; background: #F5F5F5; " | Intermittent or mild tinnitus, can only be heard when the ambient noise is low
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| |-
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| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |
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| III
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| | style="padding: 10px 10px; background: #F5F5F5; " | Persistent or moderate tinnitus, can be heard every day
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| |-
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| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |
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| IV
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| | style="padding: 10px 10px; background: #F5F5F5; " | Persistent and severe tinnitus, interfere with work and sleep
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| |-
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| |}
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| {| style="border: 3px; font-size; 190%; margin: 1px; width: 600px" align="center"
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| ! colspan="2" style="background: #5579FF; width:600px:" | {{fontcolor|#FFF|Dizziness grading system for acoustic neuromas}}
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| |-
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| ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Grade}}
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| ! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Description}}
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| |-
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| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |
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| I
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| | style="padding: 10px 10px; background: #F5F5F5; " | No dizziness or imbalance
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| |-
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| ! style="padding: 10px 10px ; background: #DCDCDC; font-weigh: bold" align="center" |
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| II
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| | style="padding 5px 5px; background: #F5F5F5; " | Occasional and mild dizziness or imbalance
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| |-
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| ! style="padding 10px 10px; background: #DCDCDC " |
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| III
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| | style="padding 5-x 5-x; background: #F5F5F5 " | Persistent or moderate vertigo or imbalance
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| |-
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| ! style="padding 10px 10px; background: #DCDCDC; " |
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| IV
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| | style="padding 5px 5px; background: #F5F5F5; " |Persistent and severe dizziness or imbalance, disturbing daily life
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| |}
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| === Tumor size and stages ===
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| 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.
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| {| style="border: 3px; font-size 190%; margin: 1px; width: 830px; align=" center "
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| ! colspan="6" style="background: #5579FF; width: 600px:" | {{fontcolor|#FFF|Main grading systems for acoustic neuromas}}
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| ! style="background: #4479BA; " | {{fontcolor|#FFF| Tumor size (CPA Maximum diameter)}}
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| ! style="background: #4479BA; " | {{fontcolor|#FFF| Sterker}}
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| ! style="background: #4479BA; " | {{fontcolor|#FFF| House}}
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| ! style="background: #4479BA; " | {{fontcolor|#FFF| Koos}}
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| ! style="background: #4479BA; " | {{fontcolor|#FFF| Samii}}
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| ! style="background: #4479BA; " | {{fontcolor|#FFF| Tumor Description}}
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| |-
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| ! style="padding: 10px 10px; background: #ABCDEF; " | 0
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| (intracanalicular)
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| ! style="padding: 10px 10px; background: #ABCDEF; " |Tube type
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| ! style="padding: 10px 10px; background: #ABCDEF; " |intracanalicular
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| ! style="padding: 10px 10px; background: #ace123; " |Grade I
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| ! style="padding: 10px 10px; background: #eee000; " |T1
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| ! style="padding: 10px 10px; background: #eee000; " |Confining to IAC
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| |-
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| ! style="padding: 10px 10px; background: #ABCDEF; " | ≤10 mm
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| ! rowspan="2" style="padding: 10px 10px; background: #ABCDEF; " | Small
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| ! style="padding: 10px 10px; background: #ABCDEF; " | Grade 1
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| (Small)
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| ! rowspan="3" style="padding: 10px 10px; background: #ace123; " | Grade II
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| ! style="padding: 10px 10px; background: #eee000; " | T2
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| ! style="padding: 10px 10px; background: #eee000; " | Superpassing IAC
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| |-
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| ! style="padding: 10px 10px; background: #ABCDEF; " | ≤15 mm
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| ! rowspan="2" style="padding: 10px 10px; background: #ABCDEF; " | Grade 2
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| (Medium)
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| ! rowspan="2" style="padding: 10px 10px; background: #eee000; " | T3a
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| ! rowspan="2" style="padding: 10px 10px; background: #eee000; " | Tumor occupying CPA
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| |-
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| ! style="padding: 10px 10px; background: #ABCDEF; " | ≤20 mm
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| ! rowspan="2" style="padding: 10px 10px; background: #ABCDEF; " | Mild
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| |-
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| ! style="padding: 10px 10px; background: #ABCDEF; " | ≤3o mm
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| ! style="padding: 10px 10px; background: #ABCDEF; " | Grade 3
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| (Moderately Large)
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| ! style="padding: 10px 10px; background: #ace123; " | Grade III
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| ! style="padding: 10px 10px; background: #eee000; " | T3b
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| ! style="padding: 10px 10px; background: #eee000; " | Tumor occupying CPA and contacting
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| the brainstem without compression
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| |-
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| ! style="padding: 10px 10px; background: #ABCDEF; " | ≤40 mm
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| ! style="padding: 10px 10px; background: #ABCDEF; " | Large
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| ! style="padding: 10px 10px; background: #ABCDEF; " | Grade 4
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| (Large)
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| ! rowspan="2" style="padding: 10px 10px; background: #ace123; " | Grade IV
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| ! style="padding: 10px 10px; background: #eee000; " | T4a
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| ! style="padding: 10px 10px; background: #eee000; " | Tumor compressing the brainstem
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| |-
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| ! style="padding: 10px 10px; background: #ABCDEF; " | >40 mm
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| ! style="padding: 10px 10px; background: #ABCDEF; " | Huge
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| ! style="padding: 10px 10px; background: #ABCDEF; " | Grade 5
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| (Giant)
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| ! style="padding: 10px 10px; background: #eee000; " | T4b
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| ! style="padding: 10px 10px; background: #eee000; " | sever brainstem displacement and deformation of fourth ventricle under tumor compression
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| |-
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| ! colspan="6" style="padding: 10px 10px; background: #DCDCDC; " |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.
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| |}
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| ==References==
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| {{reflist|2}}
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| [[Category:Otolaryngology]]
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| [[Category:Neurology]]
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| [[Category:Neurosurgery]]
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