Treatment Options – Surgery

The aim of acoustic neuroma surgery is to remove the tumour and preserve the facial nerve and to attempt to preserve your quality of life. This is, however, major intracranial surgery and because of the important site of the tumour in relation to the brainstem and cerebellum and the necessary manipulation during surgery, neurological damage may be increased at least temporarily after surgery. This may include total and permanent one-sided hearing loss where formerly there was only a mild hearing loss, problems with balance, facial weakness, eye discomfort and headaches.

Surgery to remove an acoustic neuroma is a complex procedure that can take anything from three to eight hours to perform depending upon the size of the tumour, and in some instances it can take longer. Surgical treatment necessitates a number of nights stay in hospital immediately after the operation, in a High Dependency Unit in some cases. The post-operative course requires careful nursing and physiotherapy in order to optimise your quality of life in the immediate post-operative period and in the future.

Post-operative facial nerve weakness is what concerns patients the most but the results from modern microsurgery have improved outcome beyond all recognition in the last four decades. In small tumours there is a very high chance of the patient having normal facial nerve function following surgery, and even in large tumours now the results are satisfactory in a high percentage. There are a number of procedures that can be adopted in the smaller proportion of patients whose facial nerves are not functioning satisfactorily.

One other possible complication that may occur after acoustic neuroma surgery is a leakage of cerebrospinal fluid (CSF) which may require a further procedure to seal the leak. However, modern operating techniques using microsurgery, the development of knowledge and research in this area and experienced surgeons with careful follow-up care have significantly reduced the incidence of complications for many patients. In general, the smaller the tumour at the time of surgery the smaller the risk of complications.

In some cases where acoustic neuromas are very large at presentation, it may not be possible to completely remove the tumour, and patients will require monitoring by MRI scanning afterwards to check that there is no regrowth in the residual remnant. Interval scanning in these cases is very important and if only a small portion of the tumour remains, or a fragment of tumour capsule, it is very unlikely to grow.

Symptoms such as profound hearing loss may be present post-operatively and this will mean difficulty in localising sound. There are a number of rehabilitative options that are available if this is the case. Symptoms such as tinnitus are quite unpredictable but in fifty percent of patients the tinnitus will improve post-operatively.

When balance problems relate to the size of the tumour and compression of the brainstem then balance usually improves post-operatively, although it may not return to normal. In patients with smaller tumours generally the balance remains much the same post-operatively as it was pre-operatively, particularly in the elderly. In middle age and youth there is a degree of compensation in the post-operative period and balance often improves.

Watch Mark tell his story of surgical removal by clicking here

Information for review September 2016

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