Brain Surgery

Acoustic Neuroma

Benign tumor on hearing and balance nerve

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What is this Condition?

Acoustic neuroma (vestibular schwannoma) is a benign tumor originating from the 8th cranial nerve (hearing and balance nerve). It grows slowly and typically presents with unilateral hearing loss. Early diagnosis is important.

Related Image

Vestibüler schwannoma — serebellopontin köşede (CPA), iç kulak yolu ağzında yuvarlak tümör kitlesi; özgün tıbbi atlas tarzı anatomik illüstrasyon
Vestibüler schwannoma — serebellopontin köşede (CPA), iç kulak yolu ağzında yuvarlak tümör kitlesi; özgün tıbbi atlas tarzı anatomik illüstrasyon

Diagnosis Methods

Diagnosis is made with contrast-enhanced brain MRI. Hearing tests (audiometry) and brainstem auditory evoked potential (BAEP) tests are performed.

Treatment Methods

Treatment options are determined based on tumor size. Small tumors may be monitored, medium-sized tumors treated with microsurgery, and large tumors with Gamma Knife radiosurgery.

Frequently Asked Questions About Acoustic Neuroma

Q1.Is acoustic neuroma a life-threatening tumor?▼
Acoustic neuroma is benign and does not metastasize. However, if left untreated, it can grow and compress the brainstem, leading to life-threatening complications. With early diagnosis and appropriate treatment, the prognosis is excellent.
Q2.Is it possible to preserve hearing in acoustic neuroma treatment?▼
The chance of preserving hearing depends on tumor size and chosen treatment. For small tumors (<1.5 cm), hearing preservation rate is about 50-70% with retrosigmoid surgery. With Gamma Knife treatment, hearing preservation rate is 50-60%. For large tumors, the chance of preserving hearing is very low.
Q3.What is the risk of facial paralysis after surgery?▼
With facial nerve monitoring in modern microsurgery, facial paralysis risk is minimized. In experienced centers, permanent facial paralysis risk is about 1-5% for small to medium tumors. Temporary facial weakness is more common but most patients recover within 6-12 months.
Q4.Is the watch-and-wait strategy safe?▼
For small tumors (<1.5 cm), especially in elderly patients and slow-growing tumors, the watch-and-wait strategy can be safely applied. Growth is monitored with annual MRI. In about 30-40% of cases, the tumor does not grow and treatment is not needed.
Q5.Is there a risk of acoustic neuroma recurrence?▼
After complete surgical resection, recurrence risk is about 1-5%. In subtotal (incomplete) resections or after Gamma Knife treatment, this rate is 5-10%. Long-term MRI follow-up is recommended for all patients. In recurrent cases, retreatment (surgery or radiosurgery) may be successful.
Q6.What does bilateral acoustic neuroma mean?▼
Bilateral acoustic neuroma is typical of Neurofibromatosis Type 2 (NF2) genetic disease. In this condition, bilateral tumors usually develop in the 20-30s. Genetic counseling, family screening, and close monitoring are recommended for NF2 patients. Treatment focuses on hearing preservation.

References

  1. Di Ieva A, Lee JM, Cusimano MD, eds. Handbook of Skull Base Surgery. Thieme; 2016:645-672.
  2. Youssef AS, ed. Contemporary Skull Base Surgery: A Comprehensive Guide to Functional Preservation. Springer; 2022:486-553.
  3. Sekhar LN, Fessler RG, eds. Atlas of Neurosurgical Techniques: Brain. 2nd ed. Thieme; 2015:1201-1281.
  4. Nader R, Gragnaniello C, Berta SC, Sabbagh AJ, Levy ML, eds. Neurosurgery Tricks of the Trade: Cranial. Thieme; 2014:226-245.
  5. Greenberg MS. Handbook of Neurosurgery. 10th ed. Thieme; 2023:736-816.

This content is for informational purposes and based on academic sources; consult your physician for diagnosis and treatment.

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