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Acoustic neuroma
Alternate Names : Vestibular schwannoma, Tumor - acoustic, Cerebellopontine angle tumor, Angle tumor
Treatment
- Surgery
- Goals of surgery are to remove the tumor and prevent paralysis of the face. Preserving hearing is more difficult. If a tumor is removed when it is very small, hearing may be preserved. You cannot get back any hearing that is lost before surgery. Large tumors usually result in total loss of hearing on the affected side.
- Large tumors may also press down on nerves important for movement and feeling in the face. These tumors can typically be safely removed, but the surgery often leads to paralysis of some muscles of the face.
- Extremely large tumors may also press on the brainstem, threatening other nerves and preventing the normal flow of cerebrospinal fluid. This can lead to a buildup of fluid (hydrocephalus), which can increase pressure in the head and can be life-threatening. Goals of surgery in these cases are to treat the hydrocephalus and relieve pressure on the brainstem.
- Stereotactic radiosurgery, a form of radiation therapy
- The goal is to slow or stop the tumor growth, not to cure or remove the tumor.
- Radiosurgery is often performed in elderly or sick patients who are unable to tolerate brain surgery.
- Sometimes during brain surgery to treat acoustic neuromas, not all of the tumor can be safely removed, and some of the tumor must be left behind. Radiosurgery is often used after surgery in these cases to treat the tumor that remains.
- Radiosurgery is only appropriate for small tumors, so that radiation damage to surrounding tissues can be minimized.
- Like brain surgery, radiosurgery can sometimes result in paralysis of the face or loss of hearing.
- Observation
- Since these tumors usually grow very slowly, small tumors that have few or no symptoms can be safely watched with regular MRI scans and left untreated unless they grow dangerously.
- Very often elderly patients will die of other natural causes before small, slow-growing tumors show symptoms.
Prognosis (Expectations)
An acoustic neuroma is not cancer. The tumor does not spread (metastasize) to other parts of the body, but it may continue to grow and press on important structures in the skull.
Complications
- Brain surgery can completely remove the tumor in most cases.
- Most people with small tumors will have no permanent paralysis of the face after surgery. However, about two-thirds of patients with large tumors will have some permanent facial weakness after surgery.
- Approximately one-half of patients with small tumors will get back useful hearing in the affected ear after surgery.
- There may be delayed radiation effects after radiosurgery, including nerve damage, loss of hearing, and paralysis of the face.
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Review Date : 6/12/2009
Reviewed By : Luc Jasmin, MD, PhD, Department of Neurosurgery and Gene Therapeutics Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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