An acoustic neuroma is a benign (noncancerous) usually slow growing tumor of the cranial nerve that can affect hearing and balance controlled by the brain. These tumors grow outside of the brain on the cranial nerve and can grow large enough that they may grow into the canal that connects the ear to the brain. They may also press on the brain stem and cranial nerves, which control facial movement and sensation.
Acoustic Neuroma is an old term for what is more accurately known as vestibular schwanoma. This name arises because it is an overgrowth of the schwan cells that insulate the nerve of the brain and the cranial nerves. It is vestibular because it grows off of the eighth cranial nerve, the vestibulocochlear nerve. The eighth cranial nerve is made up of three nerves: the cochlear nerve, which transmits sounds from the hearing apparatus, and the superior and inferior vestibular branches. This arises specifically from one of the vestibular branches, most often the superior vestibular branch of the eighth cranial nerve.
Who is at risk? What factors predispose a person to developing an acoustic neuroma?
Anyone is at risk for developing an acoustic neuroma. There are two known risk factors for developing acoustic neuroma, otherwise these are sporadic:
The most common presenting symptom of an acoustic neuroma is hearing loss. The canal in the skull is only big enough for the eighth and seventh cranial nerves. The eighth cranial nerve travels from inside the brain stem out through a small piece of bone into the hearing apparatus/the vestibular apparatus. As the mass grows, it tends to compress those two nerves, creating hearing loss.
Often times, patients are examined by their primary care physician and they receive an audiogram, which is a hearing test that graphically displays the results of serviceable hearing in each ear. If it is determined that there is diminished hearing, the patient may undergo an MRI, CT scan or other diagnostic imaging procedure to determine if a mass is present.
More information about CT scans
More information about MRI scans
Once an acoustic neuroma is found, the patient is seen by a neuro-otologist, a doctor who specializes in the ears, nose & throat (Otolaryngology or ENT) that specializes in that hearing apparatus. Patients commonly get sent to a neurosurgeon as well. Here at the Neurosciences Center at Brigham and Women’s Hospital, we have the Skull Base Surgery program which is a multi-disciplinary program. This program coordinates care so the patient can see the neuro-otologist and the neurosurgeon together in the same clinic.
There are three major treatment approaches for an acoustic neuroma:
There are three approaches to the surgical removal of an acoustic neuroma. The best option will be determined by a number of factors, including the patient’s overall health:
The recovery time after surgery depends on the patient’s overall health prior to and after surgery. Routine hospitalization can usually range anywhere between three and five days after surgery. Immediately following surgery, patients can expect to stay one to two days in the Intensive Care Unit (ICU) and two to three days on a hospital floor with specialized neuro trained nurses and physician assistants.
An important part of surgery for the removal of an acoustic neuroma is preserving the functionality of the facial nerve. While the facial nerve controls facial movement, it is also responsible for closing the eyelid. Closing the eyelid is so important because doing so protects the eye and specifically the cornea. If the cornea is not protected, it can lead to a cornea ulcer and potential blindness. After surgery, if the facial nerve is not working and cannot close the eyelid completely, a plastic surgeon may complete a temporary procedure where a gold or platinum weight is surgically placed into the upper eyelid to give the eyelid more mass to close fully. Neuro-Ophthalmologists (eye doctors that specialize in neurological disorders) are also a part of the multidisciplinary team approach here at the Neurosciences Center and will be part of your care after surgery to ensure the eye is cared for properly (if necessary).
Like all cranial surgeries, there is a risk of bleeding, infection, injury to the brain, and risk of injury to one of the blood vessels in the brain that may result in a stroke, coma or even death which is why having a well trained and experienced care team is vital. The goal of the surgical procedure is about removing the acoustic neuroma while simultaneously preserving the facial nerve and hearing. Depending on your age and current state of health, the recovery period for surgical removal of the acoustic neuroma is four to eight weeks. Your dedicated skull base physician assistant will guide you through each step of the surgical process and is available to answer any questions and concerns you may have throughout and during the follow-up process of your surgery.
It is important to note that none of the areas that the team is operating on has anything to do with personality, memory, language or movement and you will be the same person you were prior to surgery. You will be up and walking around the day after surgery with assistance from our dedicated neuro trained nurses during your hospitalization. Most people recover very well from cranial surgery and you may experience pain from the incision and potentially some neck stiffness, but you will get stronger each day.
Our surgeons, as part of work with a multidisciplinary team of physicians to create an individualized treatment plan for each patient in order to provide the best possible treatment. The multidisciplinary team includes specialists in neurosurgery, neuro-otology, and radiology.
Learn more about our team by visiting their physician profiles below:
Within the Department of Neurosurgery at Brigham and Women’s Hospital, we have an established Skull Base Program within the Neurosciences Center that utilizes a multidisciplinary team approach for the best treatment of each particular case of acoustic neuroma. In addition to being neurosurgeons, our team received extra training in the treatment of base of the skull surgeries, like acoustic neuromas. Our neurosurgeons are world-renowned for their expertise and advanced approaches to skull base surgery and have a routine method in which they determine the best approach to treatment on a case by case basis. Our neurosurgeons commonly work with experienced neuro-otologists, neuro-oncologists, neuro-pathologists and radiation oncologists to complete surgical procedures and determine the best method of treatment for your acoustic neuroma. With our Neurosciences Center clinic, we have the capability to coordinate your surgeon visits with other specialists along with your specialized imaging (CT, MRI, etc) on the same day and in the same space.
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Department of Neurosurgery
Brigham and Women's Hospital
60 Fenwood Road
Boston, MA 02115
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