Acoustic neuroma surgery

Specialty of Neurosurgery

What is it?        

Acoustic neuroma surgery is a procedure in which a benign mass is removed from the inner ear canal. A tumour in this area may compress the cochlear nerve (the nerve for hearing). Consequently, the patient may experience some hearing loss and tinnitus (ringing or buzzing in the ear). Patients quite often also have vertigo and vision and balance issues. The surgery is done under general anaesthetic.     

Why would you do it?

Surgery is resorted to when conventional treatment hasn’t worked and the acoustic neuroma need to be removed. Different techniques are used according to the size of the tumour, the ear condition, and other factors. The surgery removes the tumour and it should be done carefully to ensure there’s no damage to the facial nerve.  

What does it involve?

The surgery involves removing a tumour through the inner ear or an incision in the skull. If the tumour is too close to facial nerves, it may not be completely be removed. In some cases, removing the tumour may worsen symptoms, especially if there is damage to the facial, hearing, and balance nerves. The procedure has a low mortality rate and infrequent sequelae. There are some complications that may arise during surgery, such as the loss of cerebrospinal fluid from the cranial cavity.   

How to prepare for it

Before the operation, the specialist will do an ear exam. They may also carry out the following tests:     

  • Audiometry (hearing test): the specialist will play a variety of sounds and ask the patient to point them out every time they hear them. Each tone is repeated at varying levels in order to assess the level of hearing.   
  • Imaging tests: an MRI scan is considered to be the best way to confirm if there is an acoustic neuroma. If an MRI scan test can’t be done, a CT scan can be done instead, although it is not as precise.     

Post-operative care

The patient tends to be discharged 3 to 5 days after the operation. They are usually sent to the intensive care unit the first night after the procedure. After being discharged, the patient should have regular check-ups with an otolaryngologist. They will check the operation results, do a hearing test, and some imaging tests.    

Alternative treatments

There are other treatments that can help reduce acoustic neuroma.     

  • The specialist may recommend some stereotactic radiosurgery if the tumour is smaller than 3 centimetres. It involves administering a radiation dose directed at the tumour. This method does not damage the surrounding tissue or involve making an incision. The aim is to stop the tumour growing while maintaining facial nerve and hearing function. It sometimes takes a while before the results are noticeable, so image and hearing tests are performed. This treatment is a good alternative for patients who cannot have an operation.  
  • Proton beam therapy is another kind of radiotherapy that uses particles with positive charges. This is administered in the affected area in a dose strong enough to treat a tumour but so that the surrounding area is not exposed.  
  • The specialist may recommend other complementary therapies to detect any additional symptoms or complications.   

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