Acoustic neuroma treatment may vary, depending on the size and growth of the acoustic neuroma, the patient’s overall health, and if the patient is experiencing symptoms. To treat an acoustic neuroma, your doctor may suggest one or more of three potential treatment methods: monitoring (observation), surgery, or radiation therapy.
If you have a small acoustic neuroma that isn't growing or is growing slowly and causes few or no signs or symptoms, the physician may decide to monitor it, especially if the patient is an older adult or otherwise not a good candidate for surgery.
The physician may recommend that the patient have regular imaging and hearing tests, usually every six to 12 months, to determine whether the tumor is growing and how quickly. If the scans show the tumor is growing or if the tumor causes progressive symptoms or other difficulties, the patient may need to undergo treatment.
The physician may recommend surgery to remove an acoustic neuroma. The surgeon may use one of several techniques for removing an acoustic neuroma, depending on the size of the tumor, hearing status, and other factors.
The goal of surgery is to remove the tumor, preserve the facial nerve to prevent facial paralysis, and preserve hearing, if and when possible.
Surgery for an acoustic neuroma is performed under general anesthesia and involves removing the tumor through the inner ear or through a window in the skull.
The entire tumor may not be able to be completely removed in certain cases (also known as subtotal or near-total resection). For example, this may happen if the tumor is too close to important parts of the brain or the facial nerve.
Rarely, surgical removal of the tumor may worsen symptoms.
- Complications may include:
- Leakage of cerebrospinal fluid through the wound
- Hearing loss
- Facial weakness
- Facial numbness
- Ringing in the ear
- Balance problems
- Persistent headache
- Infection of the cerebrospinal fluid (meningitis)
- Stroke or brain bleeding
In experienced hands, the risk of a major complication is <1%.
- Radiation therapy
- Gamma Knife stereotactic radiosurgery
Stereotactic radiosurgery. The doctor may recommend a type of radiation therapy known as stereotactic radiosurgery. The physician may refer the patient to see a radiation oncologist for a 2nd opinion. Radiosurgery is more commonly used in patients who are elderly or if the patient has too many medical problems to undergo surgery safely.
Stereotactic radiosurgery, such as Gamma Knife, Cyberknife, or Linac radiosurgery, uses many tiny gamma rays to deliver a precisely targeted dose of radiation to a tumor while minimizing damage to the surrounding tissue. Using imaging scans (e.g., the MRI and CT), the radiation oncologist pinpoints the tumor and then plans where to direct the radiation beams.
The radiation oncologist attaches a lightweight head frame to the scalp, which has been numbed, to keep the head still during the procedure.
The goal of stereotactic radiosurgery is to stop the growth of a tumor by reducing the blood-supply to the tumor
It may take weeks, months or years before the effects of radiosurgery become evident. The radiation oncologist, in conjunction with the neurotologist, will monitor progress with follow-up imaging studies and hearing tests.
Risks of radiosurgery include hearing loss, ringing in the ear, facial weakness, facial numbness, balance problems, treatment failure (continued tumor growth), and rare risk of malignant transformation (whereby the tumor goes from a benign to malignant state).
Stereotactic radiotherapy. Fractionated stereotactic radiotherapy (SRT) delivers a small dose of radiation to the tumor over several sessions in an effort to curb the growth of the tumor without damaging surrounding brain tissue.
Proton beam therapy. This type of radiation therapy uses high-energy beams of positively charged particles called protons that are delivered to the affected area in targeted doses to treat tumors and minimize radiation exposure to the surrounding area.
In addition to treatment to remove or stop the growth of the tumor, the physician may recommend supportive therapies to address symptoms or complications of an acoustic neuroma and its treatment, such as hearing loss, tinnitus, dizziness, or balance problems.
Hearing aids and cochlear implants or other treatments may also be recommended to treat hearing loss.