The most common symptoms of an acoustic neuroma will be hearing loss, ringing in the ears and dizziness. However you should also be aware that these symptoms may actually be due to another underlying condition. There are numerous treatment options for an acoustic neuroma which will include observation, radiotherapy and surgical removal. The option that is better for you will very much depend upon the actual size of the tumour and your specific age and general health. There are two extremely important considerations when looking to treat an acoustic neuroma, and these are to preserve your facial nerves and also to save your hearing.
In order to treat acoustic neuromas you will typically require an extremely well coordinated team of medical providers. There are many different aspects that need to be considered and the overall team of medical specialists may include a neurologist, who will specialise in diseases of the nervous system. An otologist will specialise in the treatment of ear diseases; a neurosurgeon or brain surgeon; a radiologist, who is able to interpret the different medical images that will need to be taken; a neurotologist, who will specifically specialise in diseases of the ear; a radiation oncologist, who will help with your radiation therapy; and a neuro-oncologist, who specialises in the treatment of brain tumours and nervous system tumours.
As mentioned, there are three specific treatment options for acoustic neuroma:
Observation – acoustic neuromas are most often discovered when a physician is evaluating patients for a completely separate medical condition. They may also be found when the tumour is extremely small, but the patient will display subtle symptoms. These specific tumours grow very slowly, so if they are discovered whilst they are still small, they may merely need careful observation over a period of time.
You will find that if an elderly patient is diagnosed with a small tumour, the usual course of action would be to observe its rate of growth. This is especially true if there are no specific disabling symptoms present. This action will only be taken if it is expected that the tumour will not require any treatment during the said patient’s normal life expectancy. As these specific tumours grow at such a slow rate, there is no need for someone nearing the end of their life to face certain complications and the potential risks of treatment.
Many patients prefer to merely be observed if they have a tumour growing in their better ear. The tumour will usually be monitored and treatment will only ever be an option if the tumour size may lead to hearing loss, or if it is considered life-threatening. These specific patients will usually require magnetic resonance imaging (MRI) to monitor the actual growth of the tumour. If the tumour does not show any signs of growth, observation will still continue. However, if the tumour continues to grow then treatment may be needed.
Radiotherapy – this is typically known as stereotactic radiosurgery which will deliver radiation to the tumour, usually in one session and as an outpatient. The main goal of stereotactic radiosurgery is to completely stop the tumour from growing any further. Most patients are able to continue with their normal daily activities within 48 hours. Radiosurgery may also, sometimes, be required after surgery. Occasionally brain surgery, to treat acoustic neuromas, may not be able to remove the whole tumour safely and therefore some will still remain.
Surgery – the first form of surgery is microsurgical removal. The aim of surgery is twofold. Firstly, the most obvious aim is to remove the tumour, and secondly the aim is to avoid any neurologic defects such as hearing loss or facial weakness. The success of surgery will very much depend on the size of the tumour, where it is located and the actual patient’s hearing status prior to surgery.
Microscopic surgery is typically done under general anesthesia and you will usually be required to stay in hospital for at least 4 to 5 days after surgery. There are a number of surgical approaches that may be required to remove an acoustic neuroma and this should be discussed between surgeon and patient before surgery takes place.
A second form of surgery is a partial tumour removal, and this is often preferred by some patients and their surgeons. Partial removal is usually only an option if the tumour is very large. Partial tumour removal may also lead to further surgery or stereotactic radiosurgery being required in the future. Once a large part of the tumour has been removed, the result should be that the smaller tumour that remains should not threaten the patient’s health or hearing in any way. However you should be aware that hearing loss may be a result of partial removal. You will require periodic MRI scans to ensure that the remaining tumour has not started to grow again.