Acoustic Neuroma

Acoustic neuroma tumor (non-cancerous), also called vestibular schwannoma, usually affects the vestibulocochlear nerve that connects the brain to the ear. The main objective of this nerve is to transmit balance and the sound signals produced by the inner ear to the brain. With the growth of this tumor, extra pressure is exerted on nearby organs, causing various other major complications and symptoms.

Acoustic neuroma tumors can occur at any age but are mostly diagnosed in people aged between 30 and 60. Every year, one person from every 10,000 people is diagnosed with acoustic neuroma. However, early diagnosis through Remote Patient Monitoring and proper treatment plans prescribed by healthcare professionals can reduce potential complications and major symptoms.

Symptoms

The symptoms of acoustic neuroma depend upon the tumor size and location. However, symptoms appear depending on how much pressure it exerts on nearby organs. Some of the major symptoms observed are given below:

• Hearing loss: Loss of hearing is the initial symptom of acoustic neuroma. It may be initially sudden or gradual and can cause an impact on one or both ears.
• Tinnitus: In acoustic neuroma tinnitus, the diagnosed person feels constant or irregular buzzing, ringing, and hissing sounds in the affected ear.
• Balance problems: The growth of acoustic neuroma tumors affects the balance nerves. Due to this, a diagnostic person may feel dizziness, loss of balance, and unsteadiness during walking or even standing.
• Facial numbness and weakness: In rare cases, the facial nerve is affected by pressure exerted by an acoustic neuroma tumor by which one side of the face feels numb and weak.
• Headaches: Acoustic neuroma tumors can cause constant or irregular headaches due to pressure exerted by them.

When to See a Doctor

You must visit a doctor as soon as possible when you observe constant symptoms of tinnitus, hearing loss, facial numbness, balance problems, frequent headaches, or weakness. Such symptoms may be the result of acoustic neuroma and early detection leads to effective treatment to control the condition quickly.

Regular checkups and screenings are important, particularly for people aged 30 to 60, people observing the above symptoms, and those with a family history of acoustic neuroma.

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The role of MRI in diagnosing Acoustic neuroma

MRI (magnetic resonance imaging) is performed when an acoustic neuroma is suspected based on symptoms and primary physical examination. MRI is an effective tool for diagnosing and analyzing acoustic neuromas because the brain and its surroundings use magnetic fields. A Cylinder machine is used during the MRI scan, and an individual lies on the table and slides into it.

This cylindrical machine uses computer-generated radio waves and strong magnets to generate cross-sections of the area around the inner ear and the brain. The appearance, location, and size of acoustic neuroma, along with the displacement of the surrounding organs due to potential compression, can be observed. The extent of acoustic neuroma’s effect on balance functions and hearing can be assessed occasionally by further hearing tests (audiogram ) and balance assessments.

Acoustic neuroma life expectancy and survival rates

Unlike malignant tumors that spread faster to surrounding parts, Acoustic neuromas are benign tumors (non-cancerous) that can not spread to other nearby tissues although they grow in size. Different statistics and studies show that for acoustic neuroma-diagnosed persons, the survival rate of 5 years is approximately 95 percent. It means 95 percent of people diagnosed with acoustic neuroma can stay alive for 5 years after their initial treatment and diagnosis. It is important to consider that survival rates can vary with different risk factors given below:

• Tumor size: tumors small in size are related to higher survival rates and better life expectancy than tumors large in size.
• Tumor location: Tumors that are located in easily accessible areas for surgery are easier to treat with very low risks of potential complications.
• Treatment approach: Different treatment options like radiation therapy and surgery can affect the potential complications and outcomes.
• Patient’s age and overall health: The patient’s age and overall health condition and previous medical history may influence life expectancy and survival rate. Aged patients and people with underlying health conditions can have less life expectancy than healthier and younger people.

Types of acoustic neuromas

Acoustic neuromas can be categorized based on their growth pattern and specific locations because they can occur in various locations along with the vestibulocochlear nerve. Some of the main locations and types are given below:

1- Intra canalicular (or Intracanalicular vestibular schwannoma)

In this type, acoustic neuroma is restricted to the narrow bony canal (internal auditory canal)that connects the brain with the inner ear. Primary symptoms of these tumors may be tinnitus or loss of hearing.

2- Cisternal (or cerebellopontine angle tumor)

This type of tumor spreads in the space between the cerebellum, brain stem, and temporal bone from the narrow bony canal into the cerebellopontine angle. These tumors are large which is why their symptoms are crucial like balance problems, headaches, and facial numbness.

3- Dumbbell-shaped tumors

This type of tumor is dumbbell-shaped and can be produced in both narrow bony canals (internal auditory canal) & then spreads to the cerebellopontine angle. These tumors are critical to treat due to their complex-shaped growth pattern.

4- Cystic acoustic neuromas

Most of the acoustic neuromas tumors are solid but some may create fluid-filled cysts within their structure. These types of tumors are very difficult to treat because of their complex structure.

Treatment options for acoustic neuromas

Observation (watchful waiting)

This treatment approach is considered for patients with older age or with prominent medical conditions that can be risky. This is recommended when the growth of the tumor is slow or the size is small with no significant symptoms. It involves regular screening through MRI scans and other clinical evaluations.

Stereotactic radiosurgery

In this type of non-invasive treatment, the tumor area is targeted with high-dose radiation beams from different angles. These beams of radiation damage cells of the tumor which can cause tumor size to shrink and stop its growth.

Surgical removal

Larger tumors with significant symptoms including severe loss of hearing, balance problems, and facial weakness, are recommended for surgery treatments. Different surgery options are recommended depending on the patient’s medical condition, age, size, and location of the tumor. Different surgery techniques are given below:

• Retrosigmoid approach: In this surgery procedure an incision is made behind the ear and then a small portion of the skull is removed to get access to the tumor.
• Translabyrinthine approach: In this surgery procedure, the tumor is accessed through the inner ear structure by the removal of bone that is present behind the ear.
• Middle fossa approach: In this surgery procedure an incision is made in the temple area and then the tumor is accessed through the middle cranial fossa.

Acoustic neuroma surgery

If healthcare professionals recommend surgery as a treatment approach then an individual needs to understand the whole surgery procedure. The complete steps of the surgery procedure are given below:

1- Pre-operative Evaluation:

Before surgery, the patient undergoes tests to assess their health and determine if they are fit for the procedure. Various tests include blood tests, imaging tests, and discussions with different specialists.

2- Surgical Approach:

The next step is choosing a surgical approach based on the tumor’s location, size, the patient’s health, preferences, & tumor characteristics. As discussed above, the surgery methods include translabyrinthine, retrosigmoid, and middle fossa.

3- Anesthesia:

It is necessary in acoustic neuroma surgery to make the patient completely unconscious. For this purpose, general anesthesia is used to perform the surgery process.

4- Tumor Removal:

This step of surgery is very critical as the neurosurgeon will assess the tumor through an appropriate approach carefully. Then he will separate the tumor very carefully from the surrounding critical nerves like facial nerves without any damage. The main purpose of this step is to remove as many tumor portions as possible without damaging the nearby functions.

5- Closure and Recovery:

After the tumor is removed, the area is closed, and the patient is moved to the ICU for monitoring. The patient’s hospital stay will highly depend upon the progress of recovery and the complexity of the surgery.

Recovery after acoustic neuroma surgery

After successful acoustic neuroma surgery, the recovery process will vary with different factors such as the surgical approach chosen, the number of tumors removed, and the health condition. Some of the necessary precautionary measures observed during the recovery time are as follows:

Immediate postoperative care

After the successful surgery, the patient will be transferred to ICU (intensive care unit) or SNU (specialized neurosurgical unit). Here the patient’s neurological status, major signs, and other potential complications will be closely monitored.

Pain management

After surgery, the experience of pain and discomfort around the incision area and the operative site is normal. Effective pain medication will be provided to the patient to overcome pain and discomfort by the healthcare team.

Rehabilitation

Different rehabilitation techniques e.g. speech therapy, occupational therapy, & physical therapy will be required to regain the previous function, mobility, & strength. These techniques will depend upon the potential complications of surgery during the recovery process.

Managing complications and side effects

Though quite safe and successful, there are potential complications and side effects that may arise from acoustic neuroma surgery. It is important to understand these risks & to manage any complications that may occur in partnership with your healthcare team. The following are some of the potential complications and side effects of acoustic neuroma surgery:

• Facial nerve injury: The facial nerve that controls the facial muscles is located near where acoustic neuromas grow. During surgery, this nerve could be damaged leading to temporary or permanent weakness/paralysis on one side of the face.

• Hearing loss: Depending on tumor size & location as well as the surgical approach used; there is a possibility for partial or total deafness in the affected ear. In some cases, this deafness might be permanent.

• Balance problems: Balance may be affected after surgical interference with nerves controlling equilibrium thus causing temporary dizziness, vertigo, or unsteadiness while walking/standing.

• Cerebrospinal fluid (CSF) leak: Surgery could result in CSF leakage around the brain covering membranes (meninges) consequently leading to headaches and nausea among other symptoms if not handled properly.

• Infection: Just like any other operation, there is the likelihood of getting an infection at the wound site or even elsewhere within the body systems.

Stroke or other neurological complications: Although very uncommon, there is a minimal chance of getting a stroke or other neurological problems during a post-surgery period where different signs may appear depending on which part of the brain is affected.

Long-term effects & lifestyle changes

There are numerous ways in which undergoing acoustic neuroma surgery can affect your life for a long time and may necessitate certain lifestyle changes for continued well-being and successful recovery. Here is a list of some potential permanent effects:

Facial nerve function & appearance

If the surgery affects this nerve then there will be temporary or permanent weakness/paralysis on one side of the face which can cause problems with how you look. It may be necessary to seek treatment that addresses both cosmetic and functional aspects.

Emotional & psychological adjustments

Having such a procedure followed by potential long-term consequences could have an impact on your mental well-being. Therefore you must seek support where necessary so as not to be overwhelmed by these changes in life.

Dietary/ Lifestyle modifications

You may require some changes in your lifestyle and diet to speed up your recovery and healing process. You can make these changes by adopting stress management techniques, daily exercise, and activities depending on specific health conditions.

Follow-up care & monitoring

To monitor the recovery progress you must consider follow-up appointments regularly, discuss issues, and then adjust your treatment plan.

Frequently Ask Questions (FAQ’s)