Acoustic Neuroma / Vestibular Schwannoma

Acoustic neuromas, also called vestibular schwannomas, account for about 8 percent of all primary brain tumors — those that originate in the brain itself. About 95 percent are unilateral, occurring on only one side of the brain.
Although these tumors are benign, they can cause hearing loss, problems with balance and other neurological problems if left untreated and are allowed to continue to grow. Depending on the size of the tumor and factors such as age, existing hearing loss and overall health, treatments for acoustic neuroma include observation, stereotactic radiosurgery or microsurgery to remove the tumor.

About Acoustic Neuroma

An acoustic neuroma is an uncommon and location-specific type of benign tumor that occurs on the 8th cranial nerve — a major nerve that leads from the brain to the inner ear and transmits information about both sound and balance to the brain. The tumor arises from an overproduction of Schwann cells, which form around nerves to support and insulate them.

Most acoustic neuromas arise spontaneously in people between 30 and 60 years old. Possible factors that contribute to their development include continuous exposure to loud noises, previous radiation to the head or neck, or a co-occurring parathyroid tumor. Some are caused by a genetic disorder called neurofibromatosis type 2, or NF2, which causes neuromas on both sides of the brain and significant hearing loss.

Although acoustic neuromas are not cancerous, they can grow to sizes greater than 3 cm, which can put pressure on the brainstem and cerebellum and cause problems with cognition, balance and motor functions.

Symptoms of Acoustic Neuroma

Because acoustic neuromas affect a nerve involving hearing and balance, symptoms typically include:

  • Hearing loss
  • A feeling of fullness in the ear
  • Tinnitus (ringing in the ear)
  • Vertigo, or dizziness
  • Loss of balance or unsteadiness

Small or medium-sized neuromas may cause few or minimal symptoms that can mimic other conditions, or appear to be a part of aging. As tumors grow, though, they can put pressure on the brainstem or cerebellum, causing more serious problems with balance, coordination and cognition. A growing neuroma can press on adjacent nerves controlling facial motion and sensation, causing numbness and paralysis of the face.

Treating Acoustic Neuroma

Treatments for acoustic neuroma depend on a variety of factors, such as the nature and severity of symptoms, the size of the tumor itself and a patient’s age and overall health.

For some patients, particularly those who are older and have mild symptoms, doctors might choose observation or simply monitoring the tumor over time. If the tumor enlarges or symptoms get worse, interventions such as radiotherapy or surgery might be needed.

Stereotactic Radiosurgery

Gamma Knife Stereotactic Radiosurgery is a highly precise procedure that directs narrow beams of radiation directly to the tumor from different angles. This approach is often used for treating tumors in areas of the brain that might be damaged by larger single-doses of radiation. Three-dimensional conformal radiation therapy directs X-ray beams to the brain in an arrangement specifically designed to conform to the shape of the tumor. In this way, surrounding healthy tissues receive only a minimal dose of radiation.

At Neurosurgeons of New Jersey, we take full advantage of the Gamma Knife system for stereotactic radiosurgery. As a non-invasive, highly effective and durable treatment for Acoustic Neuromas in a single session with no incision our surgeons believe it is one of the best systems available for treating these types of tumors.

Radiosurgery is performed on an outpatient basis, and patients without complications can go home the same day. Possible side effects include fatigue and headaches.

Surgery

For some patients, particularly those who are younger and who have larger tumors, surgery can be performed to remove all or a portion of the tumor near the brain. At Neurosurgeons of New Jersey, we prefer (when possible) to leave the tumor within the skull and treat it with Gamma Knife radiosurgery, as this is often a safer and more effective procedure with less side effects.

When surgery is necessary, however, removing an acoustic neuroma begins with a craniotomy. The brain cancer surgeon removes a portion of the skull in order to access the tumor site, then replaces the skull after the tumor is removed. Once removed, an acoustic neuroma is unlikely to return.

Depending on the size and location of the tumor, there is a chance that removing it can result in total or partial hearing loss. Because acoustic neuromas are located so close to the facial nerves, surgery can cause some paralysis or numbness in the face. And when very large tumors are removed, related nerves and brain structures may also be affected, causing long-term problems with balance, coordination and other functions.

Recovery from surgery for an acoustic neuroma can take several weeks. Barring complications, patients typically remain hospitalized for a few days. Post-surgery effects include headache, fatigue and pain at incision sites. Rehabilitation services can help patients regain balance and deal with any neurological symptoms or hearing loss. For about one-third of patients, some delayed numbness and paralysis of the face can occur weeks after surgery.

Why Choose Neurosurgeons of New Jersey?

With the largest sub-specialized practice in the tri-state area, Neurosurgeons of New Jersey offers patient-centered care supported by state-of-the-art practices and cutting-edge technology for treating acoustic neuromas and other conditions of the brain.

Staffed by neurosurgeons and specialists with decades of research and experience, the our centers provide comprehensive care designed to meet the very specific needs of each patient. At Neurosurgeons of New Jersey, your brain tumor surgeon and healthcare team work with you to create the treatment plan that’s right for you.