What are the treatments for acoustic neuroma?
If you have a very small acoustic neuroma, your doctors might decide that the best way to treat you is just to observe and monitor it closely. This is because acoustic neuromas are very slow-growing and may not cause any symptoms for a long time. Remember, acoustic neuromas are not cancerous (malignant) and do not spread, so it is quite safe to watch things for a while. Also, treatments can have complications and side-effects. Therefore, the risks and benefits of treatment have to be balanced. If observation is recommended, your condition will be monitored with regular scans.
The main treatments for acoustic neuroma are surgery or stereotactic radiosurgery. The treatment you are offered will depend on:
- Your suitability for surgery or radiotherapy. Factors such as age and general health govern how fit you are for different treatments.
- The growth (tumour). The size and position of your acoustic neuroma will influence the type of treatment offered.
The results of the tests and scans you have can also help to determine which type of treatment is best for you and your tumour.
Either a brain surgeon (neurosurgeon) or an ENT surgeon can operate to remove an acoustic neuroma, depending on its size and location on the vestibulocochlear nerve in the brain. The surgery is carried out under a general anaesthetic.
Most people with acoustic neuroma are treated with surgery, and about 95 in 100 tumours can be removed completely. Occasionally (about 5 cases in every 100), a small part of the tumour is left behind. This is usually because it is technically too difficult to remove the whole tumour and/or there is a risk of causing more damage to the nerve or other nearby structures.
If some of the acoustic neuroma is left remaining, it can often be treated with radiotherapy. After surgery for an acoustic neuroma, you will probably have to remain in hospital for a few days for monitoring. You should be fully recovered within 6-12 weeks, and, if your tumour was completely removed, you should not need any more treatment.
This is a newer type of treatment that can be used for acoustic neuromas. Stereotactic radiosurgery involves delivering radiation to an extremely well-defined area within the brain - where your acoustic neuroma is.
Stereotactic means locating a point using three-dimensional (3D) co-ordinates. In this instance, the point is the acoustic neuroma tumour within the brain. A metal frame (like a halo) is attached to your scalp and a series of scans is performed to show the exact position of the tumour. Stereotactic radiosurgery can be given with a normal radiotherapy machine, the CyberKnife® machine, or with a technique known as gamma knife treatment.
Stereotactic radiosurgery is a very specialised type of treatment and is only available in some large hospitals. These hospitals are usually ones with both neurosurgery and cancer treatment (oncology) centres. The main advantage of this treatment is to prevent tumour growth and preserve any remaining (residual) hearing. It tends to shrink rather than remove or destroy the acoustic neuroma. It can be used for very small tumours.
What are the possible complications from the treatments for acoustic neuroma?
- Damage to the facial nerve, causing a facial nerve palsy. The facial nerve is the nerve in the brain that controls movements in the muscles of the face. If an acoustic neuroma has grown quite large, removal during surgery can potentially lead to damage of this neighbouring nerve. If the nerve is damaged, there will be paralysis of part of the face. This can cause a problem with drooping of one side of the face. In some cases, physiotherapy will help but, in others, the damage is permanent. Obviously, during surgery, great care is taken to identify and avoid damage to surrounding nerves.
- Damage to the vestibulocochlear nerve, leading to deafness. As mentioned, a degree of hearing loss is normal after treatment for acoustic neuroma. If you have NF2 and bilateral tumours, there is a strong chance that after surgery, you will completely lose the hearing in both of your ears.
- Damage to the trigeminal nerve, leading to loss of feeling (facial numbness). In the same way that the facial nerve can be damaged during surgery to remove an acoustic neuroma, the trigeminal nerve can also be injured. If this occurs, there is loss of sensation to parts of the face.
Further reading and references
Chen M, Fan Z, Zheng X, et al; Risk Factors of Acoustic Neuroma: Systematic Review and Meta-Analysis. Yonsei Med J. 2016 May57(3):776-83. doi: 10.3349/ymj.2016.57.3.776.
Nikolopoulos TP, Fortnum H, O'Donoghue G, et al; Acoustic neuroma growth: a systematic review of the evidence. Otol Neurotol. 2010 Apr31(3):478-85. doi: 10.1097/MAO.0b013e3181d279a3.
Brooker JE, Fletcher JM, Dally MJ, et al; Factors associated with anxiety and depression in the management of acoustic neuroma patients. J Clin Neurosci. 2012 Feb19(2):246-51. doi: 10.1016/j.jocn.2011.06.006. Epub 2011 Nov 2.
Van Gompel JJ, Patel J, Danner C, et al; Acoustic neuroma observation associated with an increase in symptomatic tinnitus: results of the 2007-2008 Acoustic Neuroma Association survey. J Neurosurg. 2013 Oct119(4):864-8. doi: 10.3171/2013.5.JNS122301. Epub 2013 Jun 21.
Llopez Carratala I, Escorihuela Garcia V, Orts Alborch M, et al; Radiosurgery, a treatment for acoustic neuroma. Ten years' experience. Acta Otorrinolaringol Esp. 2014 May 17. pii: S0001-6519(14)00087-9. doi: 10.1016/j.otorri.2014.03.003.
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