Acoustic neuromas are benign brain tumors that arise from the 8th cranial nerve, which is involved with hearing and balance. The tumors usually develop spontaneously in adults. In rare cases, they run in families, and these are usually neurofibromatosis type 2. Symptoms include decreased or muffled hearing, fullness or ringing in the ears, dizziness, and balance issues. The diagnosis is usually made on a special type of MRI, and in patients with pacemakers, the diagnosis could be made on a CT scan. Treatment options include observation, radiation, and surgery.
Not all acoustic neuromas need treatment. However, because hearing can deteriorate rapidly and suddenly, we may want to treat the tumor early. If a tumor becomes too large, it may not be a good candidate for radiation treatment, and treatment risks increase. Therefore, for tumors that are under five millimeters, I continue to observe the tumor with periodic MRIs and exams. For larger tumors, we assess the patient’s current age, condition, and symptoms. All acoustic neuroma treatments are about 95% successful and can be repeated or combined if necessary.
Stereotactic radiosurgery in general is performed in 1-5 sessions. Gamma Knife, a type of stereotactic radiosurgery, is done in one session.
Translabyrinthine surgery is only appropriate for patients who have no usable hearing. Other patients receive retrosigmoid surgery. Both procedures require a small incision behind the ear to remove the tumor.