Acoustic neuroma is a benign tumor involving the hearing and balance nerve at the base of the brain. Its incidence is about 1 per 100,000 people per year. Acoustic neuromas do not spread throughout the body, but can cause significant disability, even death, by local growth into nearby important brain structures.
Early symptoms of an acoustic neuroma include hearing loss, distorted sound perception, tinnitus, dizziness, and disequilibrium. Later symptoms include headache, unsteadiness, facial pain, tingling, or numbness, facial tics or weakness, double vision, and difficulty in swallowing or talking.
There are a number of tests that can be utilized to diagnose acoustic neuromas, the utility of which should be based upon a complete history and physical by an experienced physician. The definitive diagnostic test is an MRI with gadolinium enhancement. However, this is a very expensive examination that should not be used as a screening test, bypassing appropriate clinical evaluation, hearing, and balance testing.
Treatment options include observation with serial MRIs, partial or total surgical removal, and radiation therapy. The treatment depends upon the patient's symptoms, hearing level, health status, age, and the growth rate of the tumor.
Surgery is the treatment of choice for the majority of acoustic neuromas requiring intervention. There are three basic approaches: (1) through the temple, (2) through the ear, and (3) through the back of the head. The approach used depends upon the size and location of the tumor, the status of the preoperative hearing, and the experience and preference of the surgeon. The optimal treatment goal is removal of the tumor while maintaining existing hearing and facial function. In many cases, hearing in the affected ear cannot be preserved. Since acoustic neuromas are usually slow growing, partial tumor removal may be elected by the surgeon to reduce surgical time and preserve facial function. For those patients unable or unwilling to undergo surgery, radiation therapy or observation with yearly MRI scans may be alternatives.
Possible complications that may require further medical and/or surgical rehabilitation include: hearing loss, dizziness, facial weakness or paralysis, prolonged headaches, fluid leak from around the brain, and tumor recurrence.
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