Treatment Options for Acoustic Neuromas

Goals of Treatment of Acoustic Neuromas

Treatment of acoustic neuromas is based upon the patient's age, symptoms, the size of the tumor, pattern of tumor growth, and the patient's level of hearing at the time of diagnosis. The goals of treatment for acoustic neuromas include:

• Preserving hearing for patients with hearing function in the affected ear
• Local control of tumor growth either by removal of the tumor or by stopping its progression
• Avoiding damage to adjacent nerves (facial and trigeminal nerves) and brain tissue

Preservation of hearing is of the utmost importance and may determine the treatment option chosen. The highest success is achieved if the tumor is treated when it is very small. As MRI technology improves, increasing numbers of acoustic neuromas are being identified at very early stages when they are still small and hearing loss is mild. Any loss of hearing that occurs before surgery is permanent and is not recovered following surgery. Thus, great effort is put into preserving as much of the remaining hearing as possible. Large tumors may involve permanent total hearing loss on the affected side. If the tumor is extremely large and presses on the brainstem, the goal of surgery is to relieve the intracranial pressure which results from fluid accumulation in the brain and hearing preservation issues are secondary.

Another important consideration for patients diagnosed with acoustic neuroma is selecting the treatment option which is best for the prevention of facial nerve and trigeminal nerve injury and subsequent symptoms such as paresis, paralysis, tingling, or numbness.

There are three treatment options for acoustic neuromas:

• Observation ("watching and waiting")
• Tumor excision by microsurgery
• Radiosurgery