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Acoustic neuroma

Definition


Disease: Acoustic neuroma Acoustic neuroma
Category: Tumors
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Disease Definition:

Also called vestibular schwannoma, acoustic neuroma is one of the most common types of brain tumors. This tumor develops adjacent to the brain on a portion of the eighth cranial nerve, which runs from the brain to the inner ear. Luckily, acoustic neuroma is benign (noncancerous) and usually slow growing. Although acoustic neruoma doesn't invade brain tissue like cancer does, but it causes hearing loss, which is one of its symptoms that results from the tumor pressing on the nerve.

Some of the treatment options are:
 

  • Radiation
  • Regular monitoring 
  • Surgical removal


However, for some people, acoustic neruoma causes no problems because it remains so small.
 

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Although the size of the tumor doesn't always determine its effects, but it will be more likely to cause signs and symptoms as it grows. Mostly, a tumor of about 1.5 centimeters (less than almost six-tenths of an inch), may cause no symptoms. Some tumors may grow more than 6 cm (about two and a half inches).

Due to the tumor's pressing on the cranial nerves, some of these signs and symptoms may occur:
 

  • Vertigo (dizziness)
  • Numbness and weakness of the face
  • Tinnitus (ringing) in the affected ear
  • Balance loss
  • Gradual hearing loss, although it may be sudden in some cases. It usually occurs on one side only or is more pronounced on one side.
  • In some rare cases, the acoustic neuroma may become life-threatening and grow large enough to compress the brainstem.


In case a person develops ringing in their ear, or notice hearing loss, particularly in one ear, or have trouble with balance or dizziness, they should see a doctor. If the tumor grows large enough it may cause serious consequences, such as total hearing loss or a life-threatening buildup of fluid within the skull. However, if diagnosed early, these complications can be avoided. 
 

Causes:

The three branches of the eighth cranial nerve (vestibulocochlear) forward information from the inner ear to the brain. Sound is carried by the cochlear branch. Most acoustic neuromas develop on a vestibular branch, of which there are two kinds: superior and inferior, both of which carry information regarding balance.

Although in some rare cases the tumor may be an indication of neurofibromatosis 2, but its major cause is yet unknown.
Neurofibromatosis 2 is a genetic disorder that involves the growth of tumors on the vestibulocochlear nerve. The nerve will be affected on both sides (bilateral) in case the tumor is associated with neurofibromatosis.
 

Complications

Complications:

Many complications can be caused by an acoustic neuroma, such as:
 

  • Numbness and weakness of the face
  • Permanent loss of hearing
  • Balance difficulties and clumsy gait
  • The buildup of fluid in the skull (hydrocephalus), which increases the pressure inside the skull due to the prevention of the normal flow of fluid between your brain and spinal cord (cerebrospinal fluid).
     

Treatments:

Three options are available for managing an acoustic neuroma, which are:
 

  • Observation to determine how fast the tumor is growing, or if it's growing at all
  • Radiation
  • Surgical removal

 

In case the acoustic neuroma causes few or no signs and is growing slowly, or not growing at all, monitoring it may be a good idea, especially if the patient isn't a good candidate for treatment, or is an older adult.

To determine whether the tumor is growing and how quickly, regular imaging and hearing tests should be recommended. If the tumor causes progressive hearing loss or other difficulties, or if the scans show that the tumor is growing, treatment may be needed.

Surgical removal:
It is performed under general anesthesia and it involves removing the tumor through an incision in the skull. The goal of this procedure is to remove the tumor and preserve the facial nerve to prevent facial paralysis and preserve hearing. Recovery usually takes six weeks or more, and the patient should stay in the hospital four to six days after the surgery.

Stereotactic radiosurgery:
Its purpose is to stop the growth of a tumor. One of its methods is the gamma-knife radiosurgery, during which a lightweight headframe will be attached to the numbed scalp and using imaging scans, the exact location of the tumor will be determined, so that the doctor will know where to apply the radiation beams. This procedure is often performed under local anesthesia, and enables the doctor to deliver radiation precisely to a tumor without making an incision. The doctor will monitor the patient's progress with follow-up imaging studies and hearing tests, and it may take weeks, months, or even years before the effects of radiosurgery become evident.
Radiosurgery may also be used for residual tumors, which are portions of a tumor that traditional brain surgery can't remove without damaging brain tissue.
 

Prognosis:

Not available

Expert's opinion

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