Acoustic neuroma treatment options

The options open to AN patients are basically:

 surgery

 radiation

 watch & wait (no treatment)

REASONS TO CHOOSE MICROSURGERY RATHER THAN RADIATION

1. Desire to get the tumor "out of your head"

2. Fear of unknown long-term effects of radiation, such as induced malignancy

3. Size and/or position of the tumor makes radiation unadvisable (because swelling can occur after radiation     treatment)

4. The tumor has a cystic component

5. Prior radiation treatment in the same area

Key in the decision making process is determining the best type of surgery for an individual situation. Ultimately the question is, "What should I do?" and "How do I decide what to do?"

Surgery is the oldest form of treatment for acoustic neuroma tumors. Depending on the patient's tumor size and location, there are four goals in surgery: patient safety, total/partial tumor removal, facial nerve preservation and hearing preservation.

AN surgery requires exceptional care and precision and it is recommended to choose a surgeon with experience of at least 100 surgeries using the same technique, on a regular basis, recently, and with good outcome statistics. Choosing the correct medical professional and facility is critical in obtaining the best outcome.

When selecting a physician, request statistics relative to his/her own patient outcomes rather than general industry standards. Request the number of operations performed using the type of surgery you are considering.

The 3 different surgical approaches have different goals. They are discussed in detail below, but basically Translabyrinthine surgery, which is the oldest approach, sacrifices hearing in the AN ear, while making it easier to avoid damage to the facial nerve. Advances in technology and surgical tools make both facial nerve preservation and hearing preservation a reasonable expectation in some patients undergoing the Retrosigmoid approach, (also known as Suboccipital), and the Middle Fossa approach. Mainly this includes the ability to monitor the facial and hearing nerves during the surgery and the use of sophisticated surgical tools.

3 BASIC SURGICAL OPTIONS:

 Translabyrinthine

The oldest surgical approach is translabryinthine. This procedure provides the best line of sight of the facial nerve and consequently offers the highest success rate of facial nerve preservation for a patient. The downside is that this procedure sacrifices an individual's hearing. It should only be selected when a person has severe hearing loss or the tumor is too large for hearing preservation surgery. Translab is the preferred surgical choice by most doctors when the hearing level is no longer useable. It is also a good choice when a tumor is above 20 mm as, statistically, facial nerve damage increases with large tumors. The entry is behind the ear in which the mastoid bone and some bone in the inner ear is removed.

 Middle fossa

This approach will be used to attempt hearing preservation. Statistics show that the better the hearing one has ahead of the operation the better the chances of good hearing preservation. The location of the tumor on the superior nerve vs. the inferior nerve is better. The incision is made in front of the ear by creating a bone flap. There is an unobstructed view of the entire IAC with this surgical approach. This allows complete tumor removal. The middle fossa approach is performed by lifting of the temporal lobe of the brain.

 Retrosigmoid (suboccipital)

This approach is used to attempt hearing preservation. Success rates vary from 30-65% in CPA tumors smaller than 1.5 cm with good hearing and limited involvement of the IAC. However a tumor extending to the fundus is a contraindication to the RS approach for hearing preservation.