Acoustic neuroma, or vestibular schwannoma, is a noncancerous benign tumor that has a slow rate of growth. The tumor develops on the vestibulocochlear nerve, which leads from an individual’s inner ear to the brain. As the branches of this nerve influence hearing and balance, acoustic neuroma can lead to problems such as unsteadiness, loss of hearing (which can be sudden or gradual), experiencing a ringing sensation and pressure in the ear, facial pain and headaches.
The age of the patient along with their health, medical history, expected progress of the ailment, and the size and location of the tumor are some of the factors taken into consideration when it comes treatment options available for acoustic neuroma.
Specifically, treatment is divided into three categories discussed below.
There are three approaches taken in invasive surgery. Depending on the age, size of the tumor, and growth, surgeons can opt for translabyrinthine, retrosigmoid, and middle fossa. The translabyrinthine approach is taken if the patient’s hearing isn’t to be preserved. An incision is made behind the ear which allows perfect internal auditory canal and tumor exposure. A tumor of any size can be removed through this approach.
In retrosigmoid, an opening is formed behind the mastoid part of the ear which is on the side of the tumor near the back of the head. The posterior side of the tumor is exposed and there’s a chance of preserving the hearing ability of patients through this approach.
Middle fossa is performed on patients with small size tumors and for the preservation of hearing. The tumor is exposed from the upper surface of internal auditory canal by removing a small portion of the bone above the ear canal.
Patients may undergo endoscopic treatment, which is a minimally invasive acoustic neuroma treatment. A burr hole, which is the size of a dime, is made behind the mastoid rather than drilling it or cutting out a large portion of the patient’s skull to perform surgery. Once a small opening has been created behind the mastoid, highly efficient, flexible, and thin endoscopic instruments are inserted to reach the tumor site for removal.
Due to the procedure being a minimally invasive technique the brain is not manipulated, retracted or pushed. This enables faster recovery and complication rates are kept to a minimum. Patients can be discharged within 48 hours of surgery.
The technique doesn’t have an exclusion criteria and tumors as large as 6cm or as small as 6mm can be removed. The patient’s age isn’t an impeding factor either.
Acoustic Neuroma can also be treated through steretactic and fractioned stereotactic radiotherapy. The goal of this treatment is to stop the growth of the tumor without harming the important biological structures that surround it and lower complications after treatment. The tumor isn’t removed but can be shrunk with time through doses of radiation.
Several radiation sources are employed in stereotactic and fractioned stereotatic radiotherapy through different machines namely GammaKnife, and BrainLAB. The approach has been known to give results similar to invasive surgery for small and medium sized tumors. The radiation is administered to a precise or even a series of different points in order to maximize the amount of target tissues being exposed. The precision of this method helps minimize the exposure normal tissues might experience.