Acoustic Neuromas / Vestibular Schwannomas

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Diagnosing and Treating Acoustic Neuromas

An individual experiencing the symptoms of an acoustic neuroma will usually consult a primary care physician first to complain of ringing in the ears or balance problems. A physician will perform a basic neurological exam, including tests of:

  • reflexes
  • muscle strength
  • eye movement
  • coordination
  • alertness

 
If your doctor finds any cause for concern, you will probably have some imaging tests done to look for clues to the source of the symptoms. Those tests typically include magnetic resonance imaging (MRI) and computerized tomography (CT) scans, which produce detailed images of the brain and allow doctors to detect the presence of a tumor. Both of these tests are noninvasive, but they do require time in a scanner to produce tiny slices of images that are then combined into three-dimensional pictures. Sometimes the patient will need a special contrast agent in advance to increase the visibility of any abnormality found.

Some tumors are too small to show up on a scan, but a doctor may see an enlarged ear canal or a thickened acoustic nerve, both of which are clues that an acoustic neuroma may be present. If an acoustic neuroma is suspected or diagnosed, the patient should be referred to a neurosurgeon with experience in treating these tumors for an evaluation.

Functional Testing
Before a treatment plan can be developed, an individual with an acoustic neuroma should have a hearing test to determine what damage may have already occurred. The patient will probably also be graded using a test called the House-Brackmann scale, which measures any loss of function in the facial nerves. Both the hearing and facial nerve tests can help establish the existing levels of functioning, which will help the surgeon make a treatment recommendation.

The goal of treatment is to remove the tumor while preserving the current level of functioning – surgery cannot reverse hearing loss, but some surgical techniques are better able to prevent further loss.  Some surgical approaches may successfully remove the tumor but result in additional hearing loss. Neurological surgeons choose an approach based on the results of functional tests and the condition and preferences of each patient.

More about the Acoustic Neuroma Program

Treatment Options

Monitoring: If the tumor is not growing or posing any threat to surrounding nerves or tissue, or if the patient is older and surgery is a risk, then monitoring may be the treatment of choice.

Stereotactic radiosurgery (SRS): Neurosurgeons who specialize in stereotactic radiosurgery may use these highly targeted radiation beams (directed at the tumor from multiple angles) to treat small acoustic neuromas. (Stereotactic radiosurgery is not usually effective against larger tumors.) Stereotactic radiosurgery has the advantage of being non-invasive and therefore lower risk than open surgery, but it does not produce the immediate results of surgery. Find out more about Stereotactic Radiosurgery.

Surgery: Surgical removal of the acoustic neuroma is usually the best treatment option, with immediate results.  See Surgery for Acoustic Neuromas.

Experimental treatments on the horizon include intra-arterial chemotherapy using Bevacizumab (trade name Avastin). An exciting new clinical trial now underway at Weill Cornell holds promise for excellent outcomes for patients with acoustic neuromas (find out more about the clinical trial).

The neurosurgeons of the Weill Cornell Brain and Spine Center have advanced training and expertise in treating acoustic neuromas, with excellent outcomes. Find out more about the Doctors Who Treat Acoustic Neuromas.

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Reviewed by: Jared Knopman, M.D.
Last reviewed/last updated: January 2015