Abstract
Vestibular schwannomas are mostly sporadic, neuroectodermal, benign tumors of the myelin-forming cells of the vestibulocochlear nerve. Typical initial symptoms of vestibular schwannomas often include unilateral hearing loss, tinnitus, vertigo, and headaches. As schwannomas characteristically show a slow growth rate and various symptoms, different therapeutic approaches are possible, ranging from a watchful waiting strategy to radiation therapy and neurosurgical tumor removal. In addition, these treatment options should be evaluated carefully and assigned individually to the patients' needs and symptoms while respecting the feasibility and possible outcome of the chosen treatment. We present a 69-year-old patient with an atypical, severe symptom constellation and tumor growth dynamic. The planned treatment of the schwannoma with radiosurgery revealed an unforeseen change of focus. Most notably, this case emphasizes the importance of a thorough radiological and patient-orientated assessment.