The first and most important step in treating acoustic neuroma is to establish a cooperative and trusting relationship with your treatment team. Our team at UC San Diego Health takes a patient-centered approach and includes experts in surgery, radiology, genetics, radiation therapy, audiology, and rehabilitation.
We provide three treatment options. Some patients benefit most from one option or another, but for other patients, multiple options may be appropriate. Sometimes it is a matter of personal choice.
Wait and Watch
A "wait and watch" strategy can be appropriate if your tumor is small (<2 cm) and you are experiencing few symptoms. This approach generally involves a second MRI in 6 months and then annually as long as there is no growth and symptoms have not changed.
Smaller tumors may show no growth for periods of time, even over several years. However, it is important to understand that hearing often declines over time even when the tumor does not appear to be not growing.
We use and have extensive experience with all three microsurgery approaches: translabyrinthine, retrosigmoid, and middle cranial fossa. The choice of approach is individualized and depends on each patient’s needs.
- The translabyrinthine approach is performed through an incision behind the ear. The surgeon opens the mastoid bone and inner ear structures to identify the tumor within the internal auditory canal and cerebellopontine angle. This is the favored approach for larger tumors in patients with poor hearing or in cases where hearing preservation is unlikely (tumors >2 cm). This approach allows early identification of the facial nerve and has a very low incidence of postoperative headache.
- The retrosigmoid approach involves an incision slightly farther back behind the ear. This approach can be used for hearing preservation as it does not involve removal of the inner ear structures. We reserve this approach for patients with useful hearing and tumors that are 2 centimeters or less in diameter and do not extend to the farthest reaches of the internal auditory canal. This approach has a low but finite risk of chronic headache and is not recommended for patients with a history of troubling headaches.
- The middle cranial fossa approach involves an incision above the ear. The internal auditory canal is approached from above and an experienced surgeon can expose the tumor without compromising the structures of the inner ear. This procedure is reserved for patients with useful hearing and tumors smaller than 1.7 centimeters. This technique offers the highest likelihood of long-term hearing preservation.
Radiation Therapy and Radiosurgery
This is a nonsurgical approach often done in an outpatient setting. Radiation can be given as a single dose or in multiple or fractionated doses.
Radiation therapy (more than one session) or radiosurgery (single session) are useful treatment methods in appropriate circumstances. In general, radiation induces strand breaks in DNA, the genetic material of the cell. This theoretically leads to cell death and/or growth arrest in some fraction of the tumor.