treatment

Last reviewed 01/2018

The management of acoustic neuromas is undertaken via a specialist surgical team - this may involve an ENT surgeon and a neurosurgeon.

Treatment options include conservative management, gamma-knife (GK) radiosurgery, and microsurgery:

  • conservative management - due to the risk of interventions, small asymptomatic tumors may be managed by a "watch, wait and rescan" approach. This is more suitable in elderly patients with co morbid diseases
  • stereotactic radiosurgery (GK radiosurgery) - it is used in the treatment of
    • small to medium sized tumors
    • incompletely resected tumors
  • microsurgery - is useful in treating large acoustic neuromas. three surgical methods are used in approaching the CP angle
    • retrosigmoid approach
    • translabyrinthine approach
    • middle fossa approach (1)

A systemic review has examined these three options (2):

  • conservative management over a 3.1 year period showed that 51% of acoustic neuromas showed a tumour growth, 20% of acoustic neuromas ultimately required surgical intervention, and a third of the patients lost useful hearing
  • GK radiosurgery significantly reduced the percentage of acoustic neuromas that enlarged, to 8%, and reduced the percentage that underwent microsurgery to 4.6% over a 3.8 year period
  • microsurgery removed 96% of acoustic neuromas totally, with tumour recurrence, mortality, and major disability rates of 1.8%, 0.63%, and 2.9%, respectively
  • the study authors concluded that the majority of acoustic neuromas grow slowly, but ultimately require intervention. The authors concluded, based on the systematic review, that microsurgery provided the best tumour control, although mortality and morbidity were not completely eliminated

Microsurgical techniques and intra-operative monitoring of facial and auditory nerves during surgery has greatly improved the outcome of these operations with preservation of the facial nerve in 95% of patients in whom tumours of less than 2 cm diameter were removed. The larger the tumour, the greater the risks of compromising the blood supply to the brain stem and damaging the facial nerve.

Reference:

Related pages:

results of surgery