TREATMENT
The type of treatment required may vary with each patient. It is possible that a patient could be treated more than one way. This is why it is so important that once having been diagnosed with an Acoustic Neuroma the matter should be carefully and openly discussed with your Ear, Nose and Throat Specialist. In some instances a recommendation may be made not to proceed with the treatment but to monitor the Acoustic Neuroma over a period of time especially in relation to elderly people.
Until some years ago surgery was the only way to remove this tumour. However, there is now Stereotactic Radiosurgery/Therapy used to treat a number of selected Acoustic Neuroma patients. It is a non-invasive treatment and uses beams of radiation to reduce the tumour.
MICROSURGICAL REMOVAL: Over the years considerable improvements have been made with regard to surgical techniques. Microsurgical instruments and the operating microscope are routinely used. Damage to the surrounding nerve tissue has been considerably decreased and the mortality rate is extremely low. The facial nerve function is now routinely monitored during surgery, which has reduced the risk of facial nerve injury. Also cochlear monitoring is used during surgery where there is a possibility of preserving the hearing.
There is more than one microsurgical approach that can be used to remove an Acoustic Neuroma. The type of approach is determined after consideration of the patient's age, the size of the tumour and the level of hearing that is present in the affected ear. If the tumour is small, less than 1cm or so, and the hearing is good, then it is reasonable to try to preserve the hearing. For tumours that are mostly confined to the internal auditory canal, an approach via the middle fossa may be appropriate.
For larger tumours extending into the posterior fossa but generally less than 2cm or so, then a retrosigmoid approach may be used.
The first priority is to get the tumour out safely without injury to the patient in terms of life. The second is to preserve nerves to the face physically and also functioning. Thirdly, consideration is given to preservation of hearing. Where the hearing is absent or there is so little worth preserving or the tumour is too large to allow hearing preservation, then retrosigmoid or translabyrinthine approaches can be used. The latter entails drilling out the inner ear or labyrinth for access to the tumour. Preservation to the facial nerve is possible in the removal of most tumours. Final facial nerve function generally follows the size of the tumour with better results in small tumours and slightly worse results for large tumours.
Whatever approach is used the patient is observed in a special care or high dependency unit with careful monitoring for the first one or two post-operative days.
STEREOTACTIC RADIOSURGERY/THERAPY:
This section is currently being updated.