An acoustic neuroma, also known as a vestibular schwannoma, is a benign tumor on or near the balance nerve, between the inner ear and the brain. It grows slowly over a period of years, and although they do not invade the brain they can push on it as they grow, causing damage. Some symptoms for acoustic neuroma include gradual hearing loss in one ear, tinnitus, vertigo, balance problems, facial weakness, difficulty swallowing or hoarseness, headaches, confusion, and clumsiness.
Observation is also called watchful waiting. During observation, the tumor is monitored regularly with MRI scans. In some tumors, treatment may be required. Treatment can involve surgery or radiation. Radiation therapy works by causing tumor cells to die. The tumor’s growth may slow, stop, or even shrink. However, radiation cannot completely remove the tumor. Because acoustic neuromas are not cancerous and grow slowly, immediate treatment may not be necessary.
Treatment Options
Treatment options depend on your age, size of the tumor, whether or not it is actively growing, the severity of your symptoms, and any other medical conditions you may have.
The different options include:
Radiation therapy works by causing tumor cells to die. The tumor’s growth may slow, stop, or even shrink. However, radiation cannot completely remove the tumor.
Surgery for acoustic neuromas may involve removing all or part of the tumor. There are three main approaches:
Translabyrinthine involves making an incision behind the ear and removing the bone and some of the middle ear. An advantage to this approach is that it allows the surgeon to see an important cranial nerve (the facial nerve) clearly before removing the tumor. Because of the invasiveness of this procedure, it often causes complete hearing loss because it removes all or some of the hearing components of the ear.
Retrosigmoid/sub-occipital involves exposing the back of the tumor by opening the skull near the back of the head. This approach is used for removing large tumors and has a chance of preserving hearing.
Middle fossa involves removing a small piece of bone above the ear canal to access and remove small tumors confined to the internal auditory canal, the narrow passageway from the brain to the middle and inner ear. This approach allows the surgeons to preserve a patient’s hearing while removing all or most of the acoustic neuroma.
Types of Acoustic Neuroma
In Neurofibromatosis type I, an acoustic neuroma may involve the 8th nerve, but also could involve any other cranial nerve or the spinal root. It is usually found in adults.
In Neurofibromatosis type II, bilateral acoustic neuromas are present. It is usually found before the age of 21. These tumors tend to involve the entire extent of the nerve and show a strong genetic inheritance.
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