An acoustic neuroma is a benign tumor that grows from schwann cells of the vestibular nerve. Also called vestibular schwannomas, these growths commonly lead to progressive hearing loss, ringing in the ear (tinnitus) and balance problems. An acoustic neuroma often grows first in the auditory canal and then expand to compress the brain. Treatment options for acoustic neuroma include surgical resection, stereotactic radiosurgery or fractionated radiation therapy. The tumors can be slow growing and in some patients are simply observed. When tumors are present on both right and left sides of the brain, a condition called neurofibromatosis type 2 exists.
Resection is indicated for patients with larger acoustic neuroma tumors that have caused major neurological deficits from brain compression. Surgeons perform stereotactic radiosurgery as the main alternative to acoustic neuroma tumor resection with the goals of preserved neurological function and prevention of tumor growth. The long-term outcomes of radiosurgery, particularly with gamma knife technique, have proven its role in the primary or adjuvant management of this disease. Radiotherapy can be offered to the very few acoustic neuroma patients with larger tumors in whom radiosurgery may not be feasible. Patients with neurofibromatosis type 2 pose specific challenges, particularly in regard to preservation of hearing and other cranial nerve function.
The primary clinical issues include avoiding tumor-related or treatment-related mortality, prevention of further tumor-related neurologic disability, minimizing treatment risks such as spinal fluid leakage, infections, or cardiopulmonary complications, maintaining regional cranial nerve function (facial, trigeminal, cochlear, and glossopharyngeal/vagal), avoiding hydrocephalus (obstruction of spinal fluid), maintaining quality of life and employment, and reducing cost. All acoustic neuroma treatment choices should strive to meet all of these goals.