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Though impossible to predict, it is generally noted that it takes a longer period of time for older patients to recover vestibular function than for younger patients. An overall time frame for recovery, that may be different for each patient, is as follows:

• Patients will experience difficulty with equilibrium most strongly immediately following surgery.
• After approximately 2-3 days they are typically able to walk with assistance
• After 1-2 weeks, disequilibrium may occur following head motion
• After a few months, disequilibrium may result from sudden head motion
• After approximately 6 months, the brain has sufficiently compensated for the lack of complete vestibular information so that the patient no longer feels any dysfunction of balance.

Which Surgical Approach Should I Consider?

There are many factors that have to be considered regarding selecting the optimal surgical approach for acoustic neuroma surgery. These factors include:

• Hearing level
• Size of tumor
• Location of tumor
• Experience of the neurosurgeon
• Patient preference

It is essential for patients to discuss each of these issues with their surgeon before making a decision regarding which surgical approach would be most appropriate for their particular situation.

Hearing Level

If there is no hearing in the affected ear preoperatively, the translabyrinthine or suboccipital approach may be considered. It there is useful hearing, then the middle fossa approach or the suboccipital approach may be surgical options. The criteria for hearing preservation when undergoing surgery vary. Some institutions require a pure tone loss of less than 50 dB and no more than a 50% loss of speech discrimination skills. Other institutions require a maximum of a 30 dB pure tone loss with a minimum of 70% intact speech discrimination.

Size of the Tumor

Hearing preservation is easier to achieve with smaller tumors of 2 cm. or less in size. If the tumor is large, many surgeons may prefer the translabyrinthine approach in which there is no hearing preservation in order to minimize the risk of facial nerve injury. The larger the tumor, the lower the chance for success of hearing preservation following surgery and the higher the chance of complications, such as facial palsy.

Location of the Tumor

Each surgical approach offers good accessibility and visibility of different parts of the inner ear. Depending on the exact location of the tumor, the surgeon may favor one surgical approach more than another.

Experience of the Neurosurgeon

It is important to discuss with the neurosurgeon how much experience he/she has with each type of surgery. Studies clearly indicate that the risk of complications and the rate of recurrence of acoustic neuromas are closely tied with the experience of the surgeon and the hospital in which the surgery is performed. The experience of the staff taking care of the patient postoperatively is also very important.

Preference of the Patient

The patient must decide whether they have a strong preference for hearing preservation or facial nerve preservation since each surgical approach is associated with variable risks for each of these potential complications.