An acoustic neuroma, or vestibular schwannoma, is a common, non-cancerous type of tumor that grows on a nerve that runs between the brain and inner ear. Typically slow-growing, these tumors sometimes remain small enough that the best treatment is to simply monitor their progress and effects on hearing. Larger tumors may need to be treated with surgery or radiation therapy.
Surgical Resection
Several surgical approaches can be used to remove an acoustic neuroma. The choice of procedure typically depends upon the size and location of the tumor, as well as considerations about preserving hearing and surrounding nerve function. According to Merck Manuals Online Medical Library, microsurgery--a procedure that utilizes a high-magnification microscope--is often used to remove small neuromas. Because of the precise nature of the microsurgery, damage to the facial nerve can often be avoided. Individuals with larger tumors who aim to preserve their hearing may undergo middle cranial fossa surgery, an approach that involves opening the inner ear canal from the topside of the ear, or retrosigmoid surgery, which involves approaching the tumor from behind and just below the ear. A third surgery known as a translabyrinthine approach involves going straight through the ear canal to remove the tumor. Hearing cannot be spared in this type of surgery.
Stereotactic Radiosurgery
Stereotactic radiosurgery is a treatment in which a frame is fitted to a person's head and radiation beams are used to directly target and reduce the size of the acoustic neuroma. According to the Mayo Clinic, doctors use imaging scans to determine the precise location of the tumor, and the doses of radiotherapy are usually administered under local anesthesia.
Gamma-knife radiosurgery is a common type of stereotactic radiotherapy that involves a single shot of radiation. According to Johns Hopkins Medicine, stereotactic radiosurgery has fewer associated risks than surgery; however, it can take months for radiosurgery to effectively treat an acoustic neuroma.
Fractionated Radiotherapy
Fractionated radiotherapy is a type of stereotactic radiosurgery for acoustic neuroma that involves delivering fractions of radiation over the course of multiple treatments as opposed to single, full-dose radiation treatments. According to the University of Pittsburgh Department of Neurological Surgery, this approach allows for irradiation of the neuroma while theoretically weakening the toxic effects of radiation on surrounding healthy nerves and brain tissue.
Observation
Before resorting to surgery or radiation, your doctor may advise that you wait and observe the effects of your acoustic neuroma. If the tumor is small, stable in size and does not significantly affect your hearing, you may want to continue to monitor it. According to the Mayo Clinic, this may be particularly advisable for elderly patients or those whose tumors are in a location where further hearing or nerve damage are likely with treatment.
