Treatment

Your acoustic neuroma treatment may vary, depending on:

• The size and growth of the acoustic neuroma
• Your overall health
• Severity of symptoms

To treat acoustic neuroma, your doctor may suggest one or more of three potential options: monitoring, surgery or radiation therapy.

Monitoring

If you have a small acoustic neuroma that isn't growing or is growing slowly and causes few or no signs or symptoms, you and your doctor may decide to monitor it. Monitoring may be recommended if you're an older adult or otherwise not a good candidate for more-aggressive treatment.

Your doctor may recommend that you have regular imaging and hearing tests, usually every 6 to 12 months, to determine whether the tumor is growing and how quickly. If the scans show the tumor is growing or if the tumor causes progressive symptoms or other difficulties, you may need to undergo treatment.

Surgery

You may need surgery to remove an acoustic neuroma, especially if the tumor is:

• Continuing to grow
• Very large
• Causing symptoms

Your surgeon may use one of several techniques for removing an acoustic neuroma, depending on the size of your tumor, hearing status and other factors.

The goal of surgery is to remove the tumor and preserve the facial nerve to prevent facial paralysis. Removing the entire tumor may not be possible in certain cases — for example, if the tumor is too close to important parts of the brain or the facial nerve.

Surgery for an acoustic neuroma is performed under general anesthesia and involves removing the tumor through the inner ear or through a window in your skull.

Sometimes, surgical removal of the tumor may worsen symptoms if the hearing, balance, or facial nerves are irritated or damaged during the operation. Hearing may be lost on the side where the surgery is performed, and balance is usually affected temporarily.

Complications may include:

• Leaking cerebrospinal fluid through the wound or nose
• Hearing loss
• Facial weakness or numbness
• Ringing in the ear
• Balance problems
• Persistent headache
• Rarely, infection of the cerebrospinal fluid (meningitis)
• Very rarely, stroke or brain bleeding

Radiation therapy

There are several types of radiation therapy used to treat acoustic neuroma:

• Stereotactic radiosurgery. Your doctor may recommend a type of radiation therapy known as stereotactic radiosurgery. It's often used if your tumor is small (less than 2.5 centimeters in diameter), you are an older adult or you cannot tolerate surgery for health reasons.

  Stereotactic radiosurgery, such as Gamma Knife radiosurgery, uses many tiny gamma rays to deliver a precisely targeted dose of radiation to a tumor without damaging the surrounding tissue or making an incision.

  The goal of stereotactic radiosurgery is to stop the growth of a tumor, preserve the facial nerve's function and possibly preserve hearing.

  It may take weeks, months or years before you notice the effects of radiosurgery. Your doctor will monitor your progress with follow-up imaging studies and hearing tests.

  Risks of radiosurgery include:

  • Hearing loss
  • Ringing in the ear
  • Facial weakness or numbness
  • Balance problems
  • Continued tumor growth
• Stereotactic radiotherapy. Fractionated stereotactic radiotherapy (SRT) delivers a small dose of radiation to the tumor over several sessions. SRT is done to curb the growth of the tumor without damaging surrounding brain tissue.
• Proton beam therapy. This type of radiation therapy uses high-energy beams of positively charged particles called protons. Protons are delivered to the affected area in targeted doses to treat tumors and minimize radiation exposure to the surrounding area.

Supportive therapy

In addition to treatment to remove or stop the growth of the tumor, your doctor may recommend supportive therapies to address symptoms or complications of an acoustic neuroma and its treatment, such as dizziness or balance problems.

Cochlear implants or other treatments may also be recommended to treat hearing loss.