{"id":699,"date":"2017-10-24T13:38:42","date_gmt":"2017-10-24T13:38:42","guid":{"rendered":"https:\/\/wp.uthscsa.edu\/neurosurgery\/?page_id=699"},"modified":"2019-11-06T20:17:47","modified_gmt":"2019-11-06T20:17:47","slug":"acoustic-neuromas","status":"publish","type":"page","link":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/clinical-practice\/treatments\/acoustic-neuromas\/","title":{"rendered":"Acoustic Neuromas: What You Should Know"},"content":{"rendered":"

[vc_row][vc_column width=”2\/3″][vc_column_text]Overview<\/p>\n

Acoustic neuromas, also known as vestibular schwannomas, constitute approximately six percent (6%) of all brain tumors. These tumors occur in all races of people and have a very slight predilection for women over men. In the United States, approximately ten (10) people per million, per year are diagnosed with an acoustic neuroma. This translates to roughly three thousand (3,000) newly diagnosed acoustic neuromas per year in the United States based upon a population of around three hundred million.\"\"<\/p>\n

Figure A.<\/strong><\/p>\n

Illustration of the anatomy of the temporal bone and inner ear structures.\u00a0 The vestibulocochlear (VIIIth cranial nerve) nerve travels in a bony canal, the internal auditory canal, with the facial nerve.\u00a0 The brain stem and its vital structures are adjacent to this region.<\/em><\/p>\n

 <\/p>\n

Acoustic neuromas are benign fibrous growths that arise from the balance nerve, also called the eighth cranial nerve or vestibulocochlear nerve. (Figure A)\u00a0 These tumors are non-malignant, meaning that they do not spread or metastasize to other parts of the body.\u00a0 The location of these tumors is deep inside the skull, adjacent to vital brain centers in the brain stem.\u00a0 As the tumors enlarge, they involve surrounding structures which have to do with vital functions.\u00a0 In the majority of cases, these tumors grow slowly over a period of years.\u00a0 In other cases, the growth rate is more rapid and patients develop symptoms at a faster pace.\u00a0 Usually, the symptoms are mild and many patients are not diagnosed until some time after their tumor has developed.\u00a0 Many patients also exhibit no tumor growth over a number of years when followed by yearly MRI scans.<\/p>\n

Acoustic neuromas occur in two forms: sporadic and those associated with Neurofibromatosis Type II (NF II).\u00a0 Approximately ninety-five percent (95%) of all acoustic neuromas are sporadic cases and are unilateral.\u00a0 In contrast, those tumors associated with NF II are bilateral and account for approximately five percent (5%) of acoustic neuroma patients.\u00a0 Patients with sporadic acoustic neuromas tend to begin having symptoms in middle age with the average being around fifty years old at diagnosis.\u00a0 Patients with NF II present at a younger age averaging around thirty years old when they first develop symptoms.\u00a0 There is a high degree of variability, however, and patients may begin having symptoms and be diagnosed with an acoustic neuroma during childhood or young adult life, as well when elderly.<\/p>\n

NF II is a rare disease and is found in approximately one person per one hundred thousand population in the United States.\u00a0 In contrast, Neurofibromatosis Type I (a related, but different disease) is much more common being found in thirty to forty people per one hundred thousand population.\u00a0 Virtually every patient with NF II at some point manifests bilateral acoustic neuromas, while an acoustic neuroma in a patient with NF I is uncommon.\u00a0 Virtually no patients with NF I develop bilateral tumors as do those with NF II.\u00a0 Patients with NF II also have a propensity to develop benign nerve tumors in other locations which include other nerves that arise from the brain stem, as well as, nerves arising from the spinal cord and located more peripherally in the extremities.\u00a0 Patients with NF II, like all acoustic neuroma patients, benefit from the care of a team of experienced professionals who are capable of dealing with all aspects of their complicated case management.<\/p>\n

Several treatment modalities are currently used for the treatment of acoustic neuromas.\u00a0 Until recently, surgical removal of the tumor was the standard form of therapy.\u00a0 Patients now also have the option of undergoing a noninvasive radiation treatment, called stereotactic radiosurgery (aka Novalis Shaped-Beam Surgery, Gamma Knife, Cyberknife, Protom Beam, etc.) to halt the growth of the tumor.\u00a0 Some patients might also be candidates for a combination of these therapies.\u00a0 The methods of treatment are discussed in detail below.<\/p>\n

 <\/p>\n

Treatment Options<\/h3>\n

The obvious goal of therapy of any benign brain tumor is to eradicate the tumor while preserving neurologic function.\u00a0 There are many factors which come to bear in terms of the success of treatment for these tumors.\u00a0 Acoustic neuromas, because of their location in proximity to delicate brain structures and cranial nerves, are a complicated treatment problem.\u00a0 The treatment of these tumors is best left in the hands of professionals who have a significant experience with their treatment.\u00a0 Experience in dealing with all aspects of treatment is important in order to maximize success and take advantage of all therapeutic options.<\/p>\n

1. Surgical Therapy<\/strong><\/em><\/p>\n

Surgery for acoustic neuromas has been performed since the early 1900\u2019s.\u00a0 The initial successes were few and far between by the early pioneering neurosurgeons who treated this problem.\u00a0 The past twenty years have witnessed an astounding improvement in our abilities to successfully deal with these tumors while preserving the neurological function of the patient.<\/p>\n

In contemporary surgical treatment of these tumors, the vast majority of patients go on to lead a normal life following their surgery.\u00a0 The two main concerns that patients typically have is preservation of facial nerve function and of hearing.\u00a0 The facial nerve exits the brain stem and is anatomically in a position adjacent to the vestibulocochlear nerve.\u00a0 Preservation of facial nerve function is extremely important because of its cosmetic implications.\u00a0 Normal movement of the face on each side is controlled by the facial nerve.\u00a0 Any disruption leads to a loss of normal muscular tone and movement in that side of the face.\u00a0 Most experienced neurosurgeons treating acoustic neuromas report nearly 100% success with preserving the anatomical continuity of the facial nerve.\u00a0 Preserving anatomical continuity of the nerve means that the nerve is intact and was not disrupted by the surgical procedure.\u00a0 Even with an intact nerve, the functional abilities of the nerve may not be complete.\u00a0 However, results from most series over the years have shown excellent results in terms of functional outcome of the facial nerve.<\/p>\n

\"\"<\/p>\n

Figure B.<\/strong>
\nA small acoustic neuroma ( less than 1 centimeter in diameter) is typically confined to the internal auditory canal. As a tumor reaches medium size (between 1 and 3 centimeters in diameter) it extends out of the internal auditory canal and grows toward the brain stem.<\/em><\/p>\n

 <\/p>\n

One of the major recent focuses of acoustic neuroma surgery is the preservation of hearing.\u00a0 Major strides have been made in recent years in terms of improving the results of hearing preservation with surgery.\u00a0 Much like facial nerve results, the size of tumor is an influential factor.\u00a0 Also important is how well the patient hears prior to surgery.\u00a0 If the results of the hearing test (audiogram) indicate that the hearing level is sufficient to indicate a reasonable chance of success with saving the hearing during surgery, then a treatment approach is selected that is designed to save hearing.\u00a0 Otherwise, it may be advisable to choose a treatment approach that sacrifices hearing in order to obtain a total resection of the tumor.<\/p>\n

Most patients with adequate pre-operative hearing levels have small tumors which are mostly confined to the internal auditory canal.\u00a0 In these cases, either a middle fossa approach or a retrosigmoid approach to the tumor is recommended.\u00a0 Continued refinements in this approach have led to superior hearing preservation results.\u00a0 In patients with small tumors operated by the middle fossa approach, good hearing has been preserved in roughly two thirds of those patients.<\/p>\n

\"\"<\/p>\n

Figure C.<\/strong>
\nLarge tumors are those which are at least 3 centimeters in diameter.\u00a0 These tumors press on the brain stem and cerebellum and involve other sensitive nerves which arise from the brain stem surface.<\/em><\/p>\n

 <\/p>\n

2. Surgical Approaches<\/strong><\/em><\/p>\n

The choice of surgical approach depends upon the size of the tumor and the level of residual hearing detected on the audiogram.\u00a0 Again, the larger the tumor the lower the chance of saving hearing.\u00a0 The three most common surgical approaches for acoustic neuromas are the translabyrinthine, middle fossa and retrosigmoid approach.\u00a0 All of these procedures are performed under general anesthesia.\u00a0 Patients in general spend 5 days in the hospital, including the day of surgery.\u00a0 This however may vary widely amongst surgeons.<\/p>\n

    \n
  • Translabyrinthine Approach<\/strong>\u00a0\u2013 The translabyrinthine approach involves an incision that is made behind the ear.\u00a0 The mastoid bone and the balance canal structures of the inner ear are removed in order to expose the tumor.\u00a0 This approach results in complete tumor removal in nearly every case.\u00a0 One of the main advantages in this approach is that there is little or no retraction of the brain required to provide excellent exposure of the tumor. Another advantage is early and direct localization of the facial nerve which facilitates separation of the nerve from tumor, optimizing facial nerve outcome.\u00a0 After completion of tumor removal, the opening in the mastoid bone is closed with a fat graft, which is taken from the abdomen, and reconstructed with bone cement to obtain a good cosmetic result.This approach sacrifices the hearing and balance mechanism of the inner ear.\u00a0 As a consequence, the ear is made permanently deaf.\u00a0 Although the balance mechanism is removed on the operated ear, the balance mechanism in the opposite ear provides stabilization for the patient.\u00a0 Sometimes patients experience transient vertigo immediately after surgery.\u00a0\u00a0 This generally improves within the first five days following surgery and the patient has no further problems.\u00a0 In cases of larger tumors, the compensation for loss of the balance nerves on the tumor side has naturally occurred over time while the tumor has slowly grown to its large size.\u00a0 The patients rarely experience any vertigo in the early postoperative period.\"\"Figure D.
    \n<\/strong>Outline of the incision (dashed line) and the area of bone removal on the skull by the translabyrinthine approach.<\/em>Middle Fossa Approach<\/strong>\u00a0\u2013 This approach is used for small tumors and is utilized in cases when hearing is to be conserved. \u00a0An incision is made beginning just in front of the ear and extends upward in a curved fashion.\u00a0 A small opening in the bone is made above the ear, and the membrane that covers the brain is elevated away from the bone and gently held away from the bony floor of the skull.\u00a0 Bone is then removed over the top of the internal auditory canal to expose the tumor.\u00a0 Tumor removal is complete in the vast majority of cases.\u00a0 Every effort is made to preserve hearing and still completely remove the tumor.\u00a0 In these cases of small tumors, hearing is preserved in the majority of cases in our experience.\"\"Figure E:<\/strong>
    \nOutline of the middle fossa approach incision and bone flap (dashed line) used for hearing preservation cases.<\/em><\/p>\n

     <\/p>\n

    Retrosigmoid Approach<\/strong>\u00a0\u2013 An incision is made behind the ear and an opening in the skull is made behind the mastoid bone.\u00a0 The portion of the brain called the cerebellum is retracted away in order to expose the tumor.\u00a0 In most cases the tumor can be completely removed.\u00a0 Every effort is made in this approach to preserve hearing and still completely remove the acoustic neuroma.\u00a0 In some cases, because of invasion of the auditory nerve by the tumor, it is necessary to sacrifice hearing in order to completely remove the neuroma.\u00a0 The success of hearing preservation in these cases is largely dependent upon the size of the tumor and the condition of the auditory nerve in relation to the tumor.\"\"Figure F.<\/strong>
    \nOutline of incision and bone removal behind the ear for the retrosigmoid approach on the skull.<\/em><\/p>\n

     <\/p>\n

    3. Stereotactic Radiosurgery (\u201cNovalis\u201d, \u201cGamma Knife\u201d Surgery)<\/strong><\/em><\/p>\n

    Radiation therapy, in its various forms, has been applied to the treatment of acoustic neuromas.\u00a0 Historically this was done since the results of surgery in the past (prior to the 1970\u2019s) were actually quite dismal in most cases.\u00a0 However, with improvements in microsurgical technique and surgical approach, as well as, the acquisition of great experience by some surgical teams, very few patients, until the past seven to ten years, have undergone any form of radiation therapy for their acoustic neuroma.\u00a0 However, stereotactic radiosurgery is utilized more and more for the treatment of these tumors.\u00a0 Though the goal of this therapy is tumor growth control, rather than removal of the tumor, complication rates are extremely low.\u00a0 The low chance of complications, and the outpatient nature of the technique, has led to its gaining wider popularity.\u00a0 In fact, it was estimated that in the year 2000, the number of patients treated with radiosurgery equaled the number of patients treated with microsurgery for acoustic neuroma in the United States.\u00a0 Furthermore, the number of patients choosing radiosurgery is greater than those choosing microsurgery since that time.<\/p>\n

    Stereotactic radiosurgery, or Novalis Shaped-Beam surgery, is a method of delivering a radiation dose in such a way as to minimize the affects of the radiation on the surrounding normal tissues while delivering a very high dose to the tumor.\u00a0 Low dose radiation beams are aimed from many different directions to converge on the tumor and, thereby, deliver a very high radiation dose.\u00a0 This type of treatment comes in several different forms.\u00a0 These methods are variously named the Gamma Knife, LINAC, proton beam therapy, and fractionated stereotactic radiotherapy (FSR).\u00a0 The Novalis Shaped Beam system was chosen by the team at the University of Texas Health Science Center at San Antonio\u2019s Cancer Therapy and Reseach Center (CTRC) for its versatility and precision in treating tumors such as vestibular schwannomas.\u00a0\u00a0\u00a0 Questions regarding the long-term results of this therapy have been answered in part by studies published in the past few years.\u00a0 These procedures are attractive to many patients because of the at least short-term promise of low complication rates and a shorter hospital stay.\u00a0 This form of treatment is an option for patients generally with tumors measuring less than 3cm in diameter.\u00a0 Few patients with larger tumors have been treated and therefore the efficacy of such has not been demonstrated to date.<\/p>\n

    Published series of patients treated by stereotactic radiosurgery have documented the various complications that can occur with this treatment.\u00a0 This includes facial paralysis, facial numbness, hearing loss, damage to the brain stem, hydrocephalus, and dizziness. \u00a0The incidence of complications is extremely low in comparison to traditional surgery, however.\u00a0 Stereotactic Radiosurgery has become the generally accepted first line treatment for smaller tumors and has been shown to be quite effective at controlling further tumor growth.\u00a0 The question of long-term efficacy will not be answered for several more years when patients who have recently undergone this treatment are continually followed and studied for any recurrence of the tumor. Recent reports certainly have documented that it is effective in at least 90% of patients with tumors less than 3 cm in size and the durability of treatment appears encouraging.<\/p>\n

    Currently, patients of any age, or general medical condition may be considered candidates for radiosurgery.\u00a0 Certain factors will indicate that it is not the preferred form of therapy in an individual case.\u00a0 This is best discussed with a neurosurgeon who performs both radiosurgery and microsurgery for a balanced view of the risks of each form of treatment and the best chance of reaching treatment goals.<\/p>\n

     <\/p>\n

     <\/p>\n

    CASE STUDIES<\/h3>\n

    Case 1<\/strong><\/em><\/p>\n

    This 57 year-old woman presented with a several month history of tinnitus (ringing in the ears) in her left ear..\u00a0 Her doctor sent her to an Ear, Nose, and Throat (ENT) specialist who ordered an MRI scan of her brain.\u00a0 A 2 cm mass was detected in the left internal auditory canal.\u00a0 (Figure 1)\u00a0 She was then referred for consultation to Dr. Day, who ordered an audiogram.\u00a0 Her hearing was intact at a near normal level on the audiogram in the left ear.\u00a0 After consultation it was decided that the best treatment in her case was total surgical removal of the tumor via a middle fossa approach to try and save her hearing.<\/p>\n

    Her tumor was totally removed. (Figure 2)\u00a0 The facial nerve function was perfect after surgery.\u00a0 Hearing was preserved within 10% of her preoperative level on audiogram.\u00a0 She spent 5 days in the hospital (including the day of surgery) and was back to work after a one month recovery period at her home.\u00a0 She has no residual problems after surgery and her tinnitus resolved by 3 months.
    \n\"\"<\/p>\n

      \n
    • Figure 1.<\/strong>
      \nPreoperative MRI scan showing the 2 cm acoustic neuroma in the left internal auditory canal.<\/em>
      \n\"\"Figure 2.\u00a0<\/strong>
      \nPostoperative MRI scan demonstrating total resection of the acoustic neuroma on the left.\u00a0 The whitish material on the left is a fat graft placed in the area of the surgery to seal off the space containing cerebrospinal fluid.<\/em>Case 2<\/strong><\/em>A 70 year-old businessman noted several months of problems with balance and increasing numbness in the face.\u00a0 MRI scan was ordered by his personal physician.\u00a0 A quite large cystic mass in the cerebellopontine angle was discovered.\u00a0 This mass was pressing on the brainstem and the trigmeninal nerve, the nerve that provides sensation to the face.\u00a0 It was clearly the cause of the problem.\u00a0 After consulting with Dr. Day, the decision was made to perform a partial removal in order to ensure preservation of facial nerve function.\u00a0 Because of the age of the patient, this is an acceptable strategy in an older patient since the likelihood of recurrence in the patient\u2019s lifetime is lower than for a younger patient.\u00a0 With such a conservative approach, if any tumor should regrow, this can be detected early and the patient can be treated then by stereotactic radiosurgery to minimize complications.<\/p>\n

      \"\"<\/p>\n

      Figure 3.<\/strong>
      \nPreoperative MRI scan showing a 3.5 cm cystic acoustic neuroma exerting pressure on the brain stem and cerebellum.<\/em><\/p>\n

      \"\"
      \nFigure 4.\u00a0<\/strong>
      \nPostoperative MRI demonstrating no visible tumor, though a thin (1mm) rim of tumor capsule was left against the facial nerve at surgery.\u00a0 With such a \u201cradical subcapsular\u201d removal, it is unusual for the patient to have regrowth of the tumor.\u00a0 The patient had no neurologic deficits as a consequence of surgery, made a full recovery, and actually improved neurologically with the pressure off of the brain stem and trigeminal nerve.<\/em><\/p>\n

       <\/p>\n

      Case 3<\/strong><\/em><\/p>\n

      A 36 year-old woman noticed problems with her balance intermittently for six months prior to her referral.\u00a0 She had also been losing hearing in her right ear.\u00a0 An MRI scan revealed a large acoustic neuroma on the right side (Fig. 5).\u00a0 An audiogram demonstrated that she had totally lost her hearing on the right.\u00a0 After considering her options, she opted for translabyrinthine removal of the tumor.<\/p>\n

      The tumor was totally removed via surgery, with preservation of the facial nerve.\u00a0 Her facial nerve function was perfect and the patient returned to her previous job as a sales manager in one month.<\/p>\n

      \"\"<\/p>\n

      Figure 5.<\/strong>
      \nMRI of a large acoustic neuroma on the right in a 36 year-old woman.<\/em><\/p>\n

       <\/p>\n

       <\/p>\n

      FUTURE DIRECTIONS IN THERAPY<\/h3>\n

      Surgeons at the UT Health Science Center Center for Cranial Base Surgery are working to refine treatment strategies for patients with these tumors.\u00a0 Especially in the case of patients with very large tumors, a combined strategy of initial surgery to safely reduce the size of the tumor followed by Novalis Shaped-Beam surgery is ongoing and has thus far demonstrated superior facial nerve functional preservation results.<\/p>\n

      Scientists are working on various forms of treatment for acoustic neuromas that do not involve either surgery or stereotactic radiosurgery.\u00a0 The development of gene therapy may hold the most promise for a future cure of these tumors without surgery.\u00a0\u00a0\u00a0 Research is also ongoing in novel treatment strategies for other tumors that affect the base of the skull.\u00a0 Patients are involved in clinical trials of neuro-protective agents, which are being studied for their effectiveness at improving hearing preservation, as well as, facial nerve function after surgery for acoustic neuromas.<\/p>\n

       <\/p>\n

       <\/p>\n

      COMMON QUESTIONS ABOUT ACOUSTIC NEUROMAS<\/h3>\n
        \n
      1. What is an acoustic neuroma? (vestibular schwannoma)<\/strong>
        \nAn acoustic neuroma is a benign growth which arises from the hearing and balance nerve that originates from the lower portion of the brain stem.\u00a0 These tumors represent approximately six percent (6%) of all brain tumors.<\/li>\n
      2. Is the tumor benign?<\/strong>
        \nYes.\u00a0 Acoustic neuromas are benign fibrous growths that are non-malignant, meaning that they do not spread or metastasize to other parts of the body.\u00a0 These tumors are, by nature, very slow growing in general.\u00a0 They affect adjacent nervous structures by creating pressure on these structures.<\/li>\n
      3. If I have one are my children at risk for developing an acoustic neuroma?<\/strong>
        \nThe majority of acoustic neuromas are unilateral and are not hereditary.\u00a0 Ninety-five percent (95%) of cases are sporadic and only involve one side.\u00a0 This is in contrast to those tumors which are associated with a hereditary disease called Neurofibromatosis Type II (NF II).\u00a0 In these patients, the acoustic neuromas are bilateral.\u00a0 This condition is hereditary.\u00a0 NF II is a rare disease and it is found in approximately one person per one hundred thousand population in the United States.\u00a0 If someone is diagnosed with NF II, they should undergo genetic counseling.<\/li>\n
      4. Why me?\u00a0 What causes these tumors to develop?<\/strong>
        \nThe exact cause of acoustic neuromas is not currently known.\u00a0 There is ongoing research at the House Ear Institute and other centers to try and determine the genetic defects that occur in the tumor cells.\u00a0 However, no specific environmental agents have been identified which causes the development of an acoustic neuroma.<\/li>\n
      5. Does my acoustic neuroma have to be treated?<\/strong>
        \nThe majority of patients who present with an acoustic neuroma do have treatment of the tumor.\u00a0 However, these are benign, very slow growing tumors in the vast majority of cases.\u00a0 Therefore, it should be understood that it is rarely an emergent situation to undergo treatment once this tumor is diagnosed.\u00a0 Patients have time to research their options for treatment and find an experienced team to manage their care.\u00a0 Those who do elect to be observed and not undergo surgery or radiation therapy for the tumor, in general, do not exhibit significant changes in the tumor over time as documented by frequent MRI scans.\u00a0 In a recently reviewed series of one hundred and nineteen (119) patients followed conservatively over a two and a half (2 \u00bd) year average follow-up time, seventy percent (70%) of the patients did not exhibit any growth of their tumor.\u00a0 Those that do exhibit growth or cause symptoms may be treated either by surgical removal of the tumor or stereotactic radiosurgery.<\/li>\n
      6. Are there support organizations I can contact for information?\u00a0<\/strong>
        \nYes.\u00a0 The \u201cAcoustic Neuroma Association\u201d is an excellent source of information.\u00a0 The organization provides educational material regarding acoustic neuromas and the various forms of treatment and can put you into contact with its local support group organizations.<\/li>\n
      7. What are the chances I will lose my hearing?\u00a0<\/strong>
        \nThe chances of losing hearing prior to treatment depend upon many factors.\u00a0 Patients lose hearing due to these tumors from pressure effects of the tumor on the auditory nerve, as well as, invasion of the auditory nerve by the tumor.\u00a0 Similarly, the tumor can cause an obstruction of blood flow to the auditory nerve and the cochlea which results in hearing loss.\u00a0 Most patients present with hearing loss as the first symptom of their acoustic neuroma.The chances of losing hearing completely after surgery are dependent upon the size of the tumor and the level of hearing before treatment.\u00a0 Patients with poor hearing before treatment have a very low chance, with any therapy, of having their hearing preserved.\u00a0 Patients with better hearing have a much better chance of having their hearing preserved.\u00a0 As noted above, in a review of Dr. Day\u2019s experience in more than 90 patients undergoing a middle fossa approach, roughly two thirds (2\/3) of patients had their hearing preserved at a functional level.A recent publication examining a series of patients treated with stereotactic radiosurgery demonstrated that 60% of the patients reported at least some noticeable hearing loss by 4 years after radiosurgery.\u00a0 Therefore, a careful discussion with the treating neurosurgeon is necessary prior to making any decision concerning the form of therapy to be used.<\/li>\n
      8. What is the chance of losing facial nerve function?<\/strong>
        \nAn occasional patient presents with facial nerve weakness as the first symptom of their acoustic neuroma.\u00a0 These patients tend to be those with larger tumors.\u00a0 The risk of losing facial nerve function as a consequence of surgical treatment is dependent upon the expertise of the neurosurgeon and\u00a0 the size of the tumor.\u00a0 Patients with small tumors have an excellent chance of having excellent facial nerve function after surgery.\u00a0 Patients with small tumors can expect a ninety-five (95%) chance of excellent nerve function, as judged by our recent review of patients with small tumors treated by our team with a middle fossa approach.\u00a0\u00a0 Only five percent (5%) had what is considered good facial nerve function.\u00a0 The chances of losing facial nerve function with stereotactic radiosurgery is very low at the current doses of radiation utilized.\u00a0 Recent data from patients undergoing current radiation doses show no more than a 2% chance of facial nerve weakness after treatment.<\/li>\n
      9. What is the chance the tumor will come back after treatment?<\/strong>
        \nThe chance of recurrence after surgical complete resection is extremely low.\u00a0 A study of over three thousand patients with acoustic neuromas who had removal of the tumor via a translabyrinthine approach demonstrated that the recurrence rate after total resection was 0.2% in these patients.\u00a0 Recurrence rates in other surgical series have, in general, been in the zero to two percent (0-2%) range after total resection.\u00a0 Recurrence after stereotactic radiosurgery is still undetermined at this point for patients with lower radiation doses, as are being utilized at the present time.\u00a0 The radiosurgical series \u201ctumor control\u201d rates over the short-term (i.e. approximately 2.5 years) are ninety-five percent (95%).\u00a0 A recent study of gamma knife patients showed that about 90% of patients had no further growth of tumor at 8 years after treatment.\u00a0 Most of those tumors in fact had decreased in size over that time.\u00a0 However, it is still unknown whether \u201ctumor control\u201d is equivalent to the low recurrence rates seen after total surgical resection (i.e. less than 1% chance of tumor recurrence).<\/li>\n
      10. What type of doctor should I be consulting about my acoustic neuroma?<\/strong>
        \nIdeally, a neurosurgeon that has experience with the treatment of acoustic neuromas should be consulted.\u00a0 Many specialized teams exist at several centers around the country that have the necessary experience and frequently treat patients with acoustic neuromas.\u00a0 These are difficult problems that are best handled by an experienced, multidisciplinary team in order to provide the best chance for a good outcome.\u00a0 It is important to find out the level of experience of the physicians that are consulted.\u00a0 Patients should not be bashful in asking how many acoustic neuromas the doctor has treated within the past year, or in the past five to ten years, and what the results of that treatment were.\u00a0 Patients should expect to receive specific answers based on a review of the physician\u2019s own personal data.\u00a0 It is important to find out the physician\u2019s personal results with preservation of facial nerve function, hearing preservation, and the incidence of other major complications with either surgery or radiosurgery.\u00a0 Patients should probably be wary if a surgeon does not have easily produced statistical results (this usually means that he\/she does not frequently treat these tumors).\u00a0 Likewise, patients should be wary of being treated by a physician who only occasionally treats this complicated problem.<\/li>\n
      11. Is this a tumor that any general neurosurgeon or otolaryngologist should be treating?<\/strong>
        \nAgain, the experience of the surgeon and sub-specialty training influences outcome to a tremendous degree.\u00a0 Patients should seek out an experienced neurosurgeon who frequently treats these tumors and can give sound advice based upon adequate experience.<\/li>\n<\/ol>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

        [\/vc_column_text][\/vc_column][vc_column width=”1\/3″][\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"

        [vc_row][vc_column width=”2\/3″][vc_column_text]Overview Acoustic neuromas, also known as vestibular schwannomas, constitute approximately six percent (6%) of all brain tumors. These tumors occur in all races of people and have a very slight predilection for women over men. In the United States, approximately ten (10) people per million, per year are diagnosed with an acoustic neuroma. This […]<\/p>\n","protected":false},"author":161,"featured_media":0,"parent":698,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-templates\/child-page.php","meta":{"footnotes":""},"class_list":["post-699","page","type-page","status-publish","hentry"],"yoast_head":"\nAcoustic Neuromas: What You Should Know - Neurosurgery<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/lsom.uthscsa.edu\/neurosurgery\/clinical-practice\/treatments\/acoustic-neuromas\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Acoustic Neuromas: What You Should Know - Neurosurgery\" \/>\n<meta property=\"og:description\" content=\"[vc_row][vc_column width=”2\/3″][vc_column_text]Overview Acoustic neuromas, also known as vestibular schwannomas, constitute approximately six percent (6%) of all brain tumors. These tumors occur in all races of people and have a very slight predilection for women over men. In the United States, approximately ten (10) people per million, per year are diagnosed with an acoustic neuroma. This […]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/lsom.uthscsa.edu\/neurosurgery\/clinical-practice\/treatments\/acoustic-neuromas\/\" \/>\n<meta property=\"og:site_name\" content=\"Neurosurgery\" \/>\n<meta property=\"article:modified_time\" content=\"2019-11-06T20:17:47+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/lsom.uthscsa.edu\/neurosurgery\/wp-content\/uploads\/sites\/140\/2017\/10\/01.png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"23 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/lsom.uthscsa.edu\/neurosurgery\/clinical-practice\/treatments\/acoustic-neuromas\/\",\"url\":\"https:\/\/lsom.uthscsa.edu\/neurosurgery\/clinical-practice\/treatments\/acoustic-neuromas\/\",\"name\":\"Acoustic Neuromas: What You Should Know - Neurosurgery\",\"isPartOf\":{\"@id\":\"https:\/\/lsom.uthscsa.edu\/neurosurgery\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/lsom.uthscsa.edu\/neurosurgery\/clinical-practice\/treatments\/acoustic-neuromas\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/lsom.uthscsa.edu\/neurosurgery\/clinical-practice\/treatments\/acoustic-neuromas\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/lsom.uthscsa.edu\/neurosurgery\/wp-content\/uploads\/sites\/140\/2017\/10\/01.png\",\"datePublished\":\"2017-10-24T13:38:42+00:00\",\"dateModified\":\"2019-11-06T20:17:47+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/lsom.uthscsa.edu\/neurosurgery\/clinical-practice\/treatments\/acoustic-neuromas\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/lsom.uthscsa.edu\/neurosurgery\/clinical-practice\/treatments\/acoustic-neuromas\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/lsom.uthscsa.edu\/neurosurgery\/clinical-practice\/treatments\/acoustic-neuromas\/#primaryimage\",\"url\":\"https:\/\/lsom.uthscsa.edu\/neurosurgery\/wp-content\/uploads\/sites\/140\/2017\/10\/01.png\",\"contentUrl\":\"https:\/\/lsom.uthscsa.edu\/neurosurgery\/wp-content\/uploads\/sites\/140\/2017\/10\/01.png\",\"width\":432,\"height\":287,\"caption\":\"Anatomical illustration of the temporal bone and inner ear structures.\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/lsom.uthscsa.edu\/neurosurgery\/clinical-practice\/treatments\/acoustic-neuromas\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/lsom.uthscsa.edu\/neurosurgery\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Clinical Practice\",\"item\":\"https:\/\/lsom.uthscsa.edu\/neurosurgery\/clinical-practice\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Treatments\",\"item\":\"https:\/\/lsom.uthscsa.edu\/neurosurgery\/clinical-practice\/treatments\/\"},{\"@type\":\"ListItem\",\"position\":4,\"name\":\"Acoustic Neuromas: What You Should Know\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/lsom.uthscsa.edu\/neurosurgery\/#website\",\"url\":\"https:\/\/lsom.uthscsa.edu\/neurosurgery\/\",\"name\":\"Neurosurgery\",\"description\":\"Neurosurgery\",\"publisher\":{\"@id\":\"https:\/\/lsom.uthscsa.edu\/neurosurgery\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/lsom.uthscsa.edu\/neurosurgery\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\/\/lsom.uthscsa.edu\/neurosurgery\/#organization\",\"name\":\"Neurosurgery\",\"url\":\"https:\/\/lsom.uthscsa.edu\/neurosurgery\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/lsom.uthscsa.edu\/neurosurgery\/#\/schema\/logo\/image\/\",\"url\":\"https:\/\/lsom.uthscsa.edu\/neurosurgery\/wp-content\/uploads\/sites\/140\/2017\/06\/logo.png\",\"contentUrl\":\"https:\/\/lsom.uthscsa.edu\/neurosurgery\/wp-content\/uploads\/sites\/140\/2017\/06\/logo.png\",\"width\":280,\"height\":98,\"caption\":\"Neurosurgery\"},\"image\":{\"@id\":\"https:\/\/lsom.uthscsa.edu\/neurosurgery\/#\/schema\/logo\/image\/\"}}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Acoustic Neuromas: What You Should Know - Neurosurgery","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/clinical-practice\/treatments\/acoustic-neuromas\/","og_locale":"en_US","og_type":"article","og_title":"Acoustic Neuromas: What You Should Know - Neurosurgery","og_description":"[vc_row][vc_column width=”2\/3″][vc_column_text]Overview Acoustic neuromas, also known as vestibular schwannomas, constitute approximately six percent (6%) of all brain tumors. These tumors occur in all races of people and have a very slight predilection for women over men. In the United States, approximately ten (10) people per million, per year are diagnosed with an acoustic neuroma. This […]","og_url":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/clinical-practice\/treatments\/acoustic-neuromas\/","og_site_name":"Neurosurgery","article_modified_time":"2019-11-06T20:17:47+00:00","og_image":[{"url":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/wp-content\/uploads\/sites\/140\/2017\/10\/01.png","type":"","width":"","height":""}],"twitter_card":"summary_large_image","twitter_misc":{"Est. reading time":"23 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/clinical-practice\/treatments\/acoustic-neuromas\/","url":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/clinical-practice\/treatments\/acoustic-neuromas\/","name":"Acoustic Neuromas: What You Should Know - Neurosurgery","isPartOf":{"@id":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/#website"},"primaryImageOfPage":{"@id":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/clinical-practice\/treatments\/acoustic-neuromas\/#primaryimage"},"image":{"@id":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/clinical-practice\/treatments\/acoustic-neuromas\/#primaryimage"},"thumbnailUrl":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/wp-content\/uploads\/sites\/140\/2017\/10\/01.png","datePublished":"2017-10-24T13:38:42+00:00","dateModified":"2019-11-06T20:17:47+00:00","breadcrumb":{"@id":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/clinical-practice\/treatments\/acoustic-neuromas\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/lsom.uthscsa.edu\/neurosurgery\/clinical-practice\/treatments\/acoustic-neuromas\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/clinical-practice\/treatments\/acoustic-neuromas\/#primaryimage","url":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/wp-content\/uploads\/sites\/140\/2017\/10\/01.png","contentUrl":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/wp-content\/uploads\/sites\/140\/2017\/10\/01.png","width":432,"height":287,"caption":"Anatomical illustration of the temporal bone and inner ear structures."},{"@type":"BreadcrumbList","@id":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/clinical-practice\/treatments\/acoustic-neuromas\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/"},{"@type":"ListItem","position":2,"name":"Clinical Practice","item":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/clinical-practice\/"},{"@type":"ListItem","position":3,"name":"Treatments","item":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/clinical-practice\/treatments\/"},{"@type":"ListItem","position":4,"name":"Acoustic Neuromas: What You Should Know"}]},{"@type":"WebSite","@id":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/#website","url":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/","name":"Neurosurgery","description":"Neurosurgery","publisher":{"@id":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/#organization","name":"Neurosurgery","url":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/#\/schema\/logo\/image\/","url":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/wp-content\/uploads\/sites\/140\/2017\/06\/logo.png","contentUrl":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/wp-content\/uploads\/sites\/140\/2017\/06\/logo.png","width":280,"height":98,"caption":"Neurosurgery"},"image":{"@id":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/#\/schema\/logo\/image\/"}}]}},"toolset-meta":{"tab-content-pills-accordions":[]},"_links":{"self":[{"href":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/wp-json\/wp\/v2\/pages\/699","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/wp-json\/wp\/v2\/users\/161"}],"replies":[{"embeddable":true,"href":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/wp-json\/wp\/v2\/comments?post=699"}],"version-history":[{"count":0,"href":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/wp-json\/wp\/v2\/pages\/699\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/wp-json\/wp\/v2\/pages\/698"}],"wp:attachment":[{"href":"https:\/\/lsom.uthscsa.edu\/neurosurgery\/wp-json\/wp\/v2\/media?parent=699"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}