Acoustic neuroma

Alternative names:

Vestibular schwannoma; tumor - acoustic; cerebellopontine angle tumor; angle tumor

Treatment:

• Surgery
• Goals of surgical treatment are removal of the tumor and prevention of facial paralysis. Preservation of hearing is more difficult. If a tumor is removed when it is very small, hearing may be preserved. Any hearing that is lost prior to surgery will not be regained. Large tumors usually result in total loss of hearing on the affected side.
• Large tumors may also compress nerves important for facial movement and sensation. These tumors can typically be safely removed, but the surgery often results in paralysis of some facial muscles.
• Extremely large tumors may additionally compress the brainstem, threatening other cranial nerves and preventing the normal flow of cerebrospinal fluid. This can lead to a buildup of fluid in the head (hydrocephalus) which can cause potentially life threatening increased intracranial pressure. Goals of surgery in these cases are treatment of the hydrocephalus and decompression of the brainstem.

• Stereotactic radiosurgery
  • The goal of radiation therapy 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 residual tumor must be left behind; radiosurgery is often used postoperatively to treat residual tumor in these cases
  • 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 facial paralysis or loss of hearing

• Observation
• Since these tumors usually grow very slowly, small tumors that have minimal or no symptoms (asymptomatic) can be safely observed with regular MRI scans
• Very often elderly patients will die of other natural causes before small, slow growing tumors become symptomatic

Surgical removal of the tumor is the only known treatment for acoustic neuroma.

Expectations (prognosis):

Acoustic neuromas are benign and noncancerous. They do not spread (metastasize) to other body systems, but they may continue to grow and compress vital structures within the skull.

Complications:

• Brain surgery results in complete removal of the tumor in greater than 95% of cases with a less than 1% mortality
• About 95% of patients with small tumors will have no permanent facial paralysis following surgery; however, roughly two-thirds of patients with large tumors will have some permanent facial weakness following surgery
• Approximately one half of patients with small tumors will retain useful hearing in the affected ear following surgery
• There may be delayed radiation effects following radiosurgery, including nerve damage, loss of hearing, and facial paralysis

Calling your health care provider:

Call for an appointment with your health care provider if hearing loss occurs or worsens.

Update Date: 06/22/00
Christopher J. Winfree, M.D. Resident, Department of Neurological Surgery, New York Presbyterian Hospital