Acoustic Neuroma Removal

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Acoustic Neuroma Removal

(Neurilemmoma; Vestibular Schwannoma)

Definition

An acoustic neuroma is a benign (noncancerous) tumor. It grows on the acoustic nerve, which runs from the brain to the ear. This type of tumor typically grows slowly. It may cause hearing loss, balance problems, facial numbness, and headaches.

The Acoustic Nerve

There are three main treatment options for an acoustic neuroma:

Careful monitoring
Radiation therapy
Microsurgical removal

This fact sheet focuses on microsurgical removal.

Reasons for Procedure

Tumor is growing
Concern that tumor size may become life-threatening
Tumor is causing hearing problems

A successful procedure results in complete removal of the tumor with minimal additional hearing loss.

Possible Complications

Side effects may be temporary or permanent. If you are planning to have this surgery, your doctor will review a list of possible complications, which may include:

Hearing loss
Excessive eye dryness
Difficulty with balance
Ringing in your ears ( tinnitus )
Facial weakness and numbness on the side of the tumor
Headaches
Infection
Bleeding
Leakage of cerebrospinal fluid (CSF)

Some factors that may increase the risk of complications include:

Smoking
Increased age
Size of the tumor

What to Expect

Prior to Procedure

The following medicines may be given before the procedure:

Steroids—usually started 48 hours before surgery
Antibiotic—given by IV right before surgery

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure. These may include:

Aspirin or other anti-inflammatory drugs
Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)

Anesthesia

General anesthesia will be used. You will be asleep.

Description of the Procedure

The type of procedure will depend on your case. Factors such as hearing status and the size and location of the tumor will be considered. One of the following surgical methods will be selected:

Translabyrinthine

This approach is often used when you already have significant hearing loss. The mastoid bone (part of skull) and bone in the inner ear will be removed. This allows access to the ear canal and the tumor.

Retrosigmoid/Sub-occipital

An opening will be made in the skull behind the ear. This approach is used for large or small tumors. It makes it easier to see and protect the nerves during surgery.

Middle Fossa

The tumor will be removed from the upper surface of the ear canal. This approach is used when there is a good chance that hearing may be maintained.

Immediately After Procedure

You will spend at least one night in the intensive care unit for care and observation.

How Long Will It Take?

The surgery takes about 6-12 hours. The exact length will depend on the size and location of the tumor.

How Much Will It Hurt?

Anesthesia will prevent pain during the procedure. You may notice pain after the procedure. Talk to your doctor about medicines to help manage the pain.

Average Hospital Stay

The usual length of stay is 4-7 days. Your stay may be longer if there are complications.

Post-procedure Care

At the Hospital

During recovery, you may have some of the following:

Head discomfort
Fatigue and sleepiness
Emotional lows
Headache
Dizziness
Nausea

Staff will help you manage these problems.

At Home

When you return home, follow these guidelines for a safe recovery:

Keep the incision area clean and dry.
Do not drive until your doctor allows it.
Ask your doctor when you will be able to return to work.
Ask your doctor when it is safe for you to shower, bathe, or soak in water.
Take medicines as instructed.

Full recovery typically takes 4-6 weeks. MRI scans will be done regularly over the next several years. The scans will check to see if the tumor returns.

Call Your Doctor

After you leave the hospital, contact your doctor if you have:

Signs of infection, including fever, chills, and neck stiffness
Worsening headache
Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
Nausea and/or vomiting that you cannot control with the medicines you were given after surgery or that persists for more than two days after discharge from the hospital
Pain that you cannot control with the medicines you have been given
Cough, shortness of breath, or chest pain
Stiff neck
Runny nose

In case of an emergency, call for medical help right away.

RESOURCES

American Hearing Research Foundation http://www.american-hearing.org/

National Institute on Deafness and Other Communication Disorders http://www.nidcd.nih.gov/

CANADIAN RESOURCES

The Canadian Hearing Society http://www.chs.ca/

Canadian Society of Otolaryngology http://www.entcanada.org/

References

Acoustic neuroma. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 18, 2012. Accessed October 29, 2012.

Bennett M, Haynes DS. Surgical approaches and complications in the removal of vestibular schwannomas. Otolaryngol Clin North Am . 2007;40(3):589-609.

What is an acoustic neuroma? Acoustic Neuroma Association website. Available at: http://anausa.org/index.php/overview. Accessed October 29, 2012.

6/2/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

Revision Information

Reviewer: Marcin Chwistek, MD
Review Date: 10/2012 -
Update Date: 10/29/2012 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Cartersville Medical Center