The acoustic neuroma by virtue of its situation may cause symptoms and signs by gradual encroachment on anatomically related structures. The seventh and eighth cranial nerves confined within the internal auditory meatus are the first to be involved. Next, the fifth cranial nerve at its pathway next to the brain stem may become involved as the neuroma spreads to the posterior fossa. The 9th, 10th, and 11th cranial nerves situated in the jugular foramen inferior and slightly posterior to the internal auditory meatus are next most vulnerable. The cerebellum, as the tumor spreads posteriorly into the confined cerebellopontine angle, can next be encroached upon. Finally, in the late stages of the condition when the tumor assumes relatively large dimensions, the brain stem can be involved. Thus the respiratory center, the cardiovascular center, and long ascending and descending tracts connecting the brain and spinal cord may be affected. It will be
HITSELBERGER WE, HOUSE WF. Other Cranial Nerves and Cerebellar Signs. Arch Otolaryngol. 1964;80(6):693–694. doi:10.1001/archotol.1964.00750040709010
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