You’ve been having some dizziness lately and, you feel like your hearing is blunted. You make an appointment with your physician and, after some tests, you’re diagnosed with an acoustic neuroma. That means you might have to undergo some type of acoustic neuroma surgery.
What is an acoustic neuroma? What are the treatment options? What does recovery look like? Will your hearing be preserved? Will you have an acoustic neuroma scar?
Don’t fret! This article will have all the information you need to make the right choices for your acoustic neuroma treatment. Let’s begin by reading about what exactly an acoustic neuroma is.
What Is an Acoustic Neuroma?
An acoustic neuroma is a tumor that affects the auditory nerves. The tumors grow near the hearing nerve and presses on the balance nerves, which can cause dizziness and hearing problems. Acoustic neuromas are caused by Schwann cells that overgrow. If the tumor isn’t detected early, it can grow to sizes that can cause permanent hearing loss and even hydrocephalus, which is the medical term for when excess spinal fluid builds up in the brain.
Patients with acoustic neuromas often experience dizziness, tinnitus, and random instances of vertigo. Fortunately, acoustic neuromas are non-cancerous. While a common treatment option for acoustic neuromas is surgical removal, there are other non-invasive treatment options such as Gamma Knife treatment if you want to avoid long recovery time and scarring.
Let’s take a look at the common surgical treatments first.
Surgical Options that Result in Acoustic Neuroma Scars
There are 3 main approaches when it comes to having an acoustic neuroma surgically removed. All 3 involve a craniotomy and/or craniectomy, which means that a surgeon has to cut through your skull to access the tumor.
- Suboccipital approach: Also known as the retrosigmoid approach, the surgeon makes a 5-6 inch incision behind the ear and cuts a piece of skull out of the skull base. This allows them access to the acoustic neuroma via detection of the facial nerve. This is the method most used for small to medium-sized acoustic neuromas.
- Middle Fossa approach: This approach involves an incision in front of the ear. One main risk of this approach is that hearing loss will occur due to the exposure of the auditory nerve. However, this approach is well-suited for tumors isolated to the internal auditory canal proper.
- Translabyrinthine approach: This option is used when the patient already has experienced hearing loss and involves a larger incision around the ear. The surgeon uses a drill to remove a circumferential area around the mastoid bone and temporal bone of the skull until they reach the acoustic neuroma through a reasonable corridor. The main advantage of this method is early detection of the facial nerve, which can help prevent facial weakness during recovery.
The main goal of invasive surgery is maximal safe removal of the tumor with minimal injury to the facial nerve and brainstem. The advantages of removing the tumor are that any pre-existing compression of the brainstem or neighboring structures can be reduced. The risks for these types of surgeries include, but are not limited to, a long recovery period, potential hearing loss, facial weakness, infection, spinal fluid leaking and incision healing.
As all of these surgeries are considered invasive. By the very nature of the surgery, all patients are left with surgical scars in the scalp. That said, many scars can be planned to be within a patient’s hairline and cosmetic results are often quite good. However, if you’re worried about having an acoustic neuroma scar or are concerned about the risks involved, there is an option for you.
Gamma Knife Radiosurgery for Acoustic Neuromas
Gamma Knife is a type of stereotactic radiosurgery that is non-invasive and is a well-established and relatively popular treatment for acoustic neuroma.
The procedure only takes a few hours to complete and doesn’t require a hospital stay. Most patients are back to their regular activities in one to two days. This option is great for ensuring that only tumor tissue is being affected; this means that the hearing apparatus (cochlea) is protected and there is minimal to no impact on facial nerve or brainstem function.
Patients are fitted with a head stabilizer (frame) and, an MRI is done while wearing it to precisely locate the tumor in 3D space. The Gamma Knife team will then prescribe a precise plan of focused radiation to kill the acoustic neuroma cells. It is this single shot of focused gamma radiation that results in tumor growth control.
Gamma Knife radiosurgery is a great option for patients that want a non-invasive treatment for their acoustic neuroma. There isn’t any surgical scarring because absolutely no incisions are made in the skin.
In the majority of patients that choose Gamma Knife treatment, the growth of the tumor is stalled for the rest of their lives. However, there have been instances of tumors that grow after radiation treatment. In these rare cases, Gamma Knife can often be repeated with reasonable success rates. Alternatively, if the tumor grows to a size that causes compressive symptoms, traditional surgery can be performed.
Recovery After Gamma Knife Treatment
With Gamma Knife radiosurgery, recovery only takes a few days. The most common side effects following Gamma Knife radiosurgery after the treatment of acoustic neuromas involve mild headaches, fatigue, and irritation where the head frame was placed. Delayed swelling of the tumor can occur 6 months after treatment, but medications prescribed by your doctor can manage any minor symptoms that result due to temporary tumor swelling.
If you think that Gamma Knife radiosurgery is the best option for your acoustic neuroma, feel free to contact us and set up a consultation with a qualified Gamma Knife neurosurgeon.