Vestibular Schwannoma

A vestibular schwannoma (also called an acoustic neuroma) is a benign (noncancerous) tumor that develops in the balance and hearing nerves. Vestibular schwannomas usually grow slowly and do not spread to other parts of the body.

Vestibular schwannomas may cause hearing loss and nerve damage. If the tumor grows large enough, it can press against brain structures, which can be life-threatening.

Symptoms of a vestibular schwannoma

Patients with a vestibular schwannoma may experience:

  • Balance problems
  • Facial numbness
  • Headaches
  • Hearing loss (suddenly or over time)
  • Tinnitus

If your doctor suspects a vestibular schwannoma, you may need a complete evaluation and MRI scan.

Treatment for a vestibular schwannoma

Treatment plans are based on the size and location of the tumor, symptoms and the patient’s age and general health. Treatment options include:

Observation

For small, slow-growing tumors that don’t cause symptoms, you and your doctor may decide on a "wait-and-see" approach. Observation is a good option for older adults with health problems that may be made worse by surgery.

You'll have regular checkups for hearing, balance, tinnitus and facial nerve function. You'll also need an MRI every 6 months to a year.

Advantages of observation

  • You may not need surgery.
  • You may not need to undergo radiation.

Disadvantages of observation

  • The tumor will not go away.
  • You must have regular MRIs.
  • Hearing loss and dizziness may develop or get worse, even if the tumor doesn’t grow.
  • It may be more difficult to perform hearing preservation surgery later.
  • It may be more difficult to preserve normal facial function if your tumor grows or attaches to a facial nerve.

Radiotherapy

Stereotactic radiation therapy (also called radiosurgery) uses energy to reduce the size of a tumor or limit its growth. Radiosurgery can be performed with a:

  • Gamma knife: A device, which does not use a knife, that delivers gamma rays, a type of high-energy radiation.
  • Linear accelerator: A device that uses microwave technology to deliver a high, targeted dose of radiation.

Radiosurgery minimizes the dose of radiation to surrounding normal tissue while delivering a very high dose to the tumor. Radiosurgery is performed in a single session without anesthesia. It requires a 1-to-2-day hospital stay.

Fractionated radiosurgery applies radiation in stages over 2 to 5 sessions. It's sometimes performed on large tumors or those located near critical structures.

Advantages of radiation

  • Radiation is a good way to control small tumors.
  • You may not need surgery.
  • You’ll be in the hospital for only a day or two.
  • Recovery is quick.

Disadvantages of radiation

  • The tumor does not go away and tumor cells stay alive.
  • The tumor can grow and surgery may be required at a later date.

Surgery

The objective of surgery is to remove the tumor without causing complications. Sometimes only part of a tumor can be removed. Surgery is performed under general anesthesia and requires a 4-to-6-day hospital stay.

You and your physician will discuss the best surgical approach for you based on the size and location of your tumor and the degree of hearing loss. Possible surgical approaches include:

  • Translabyrinthine approach
    A small incision is made behind the ear. The bone behind the ear and the inner ear structures are removed to provide access to the tumor. Then, the tumor is removed. The area where the bone was removed is filled with fat from the belly and may be covered with a titanium plate.

    After this surgery, your ear will be permanently deaf. Most patients compensate well. Some choose to have a bone anchored hearing aid or other type of hearing aid.

    This approach offers the best facial nerve protection.

  • Middle fossa approach
    An incision is made above the ear, and a section of bone is temporarily removed from the side of the skull. The brain is gently pulled out of the way and the tumor is removed. The brain is then released and the skull is repaired.

    With this surgery, hearing is often preserved.

  • Retrosigmoid approach
    An incision is made far behind the ear, and a section of bone is temporarily removed from the side of the skull. The brain is gently pulled out of the way to expose the tumor at the level of the brain stem. Part of the tumor is removed so the surgeon can see the facial and hearing nerves. Then, bone is drilled away to expose more of the nerves and tumor, and the rest of the tumor is removed. The brain is then released and the skull is repaired.

    With this surgery, hearing is often preserved.

Advantages of surgery

  • The tumor is usually completely removed and isn't likely to come back.
  • Only 1 follow-up MRI is needed.
  • If hearing is preserved, it remains stable over time.
  • There are very few long-term side effects.

Disadvantages of surgery

  • There is always a risk to surgery in the brain area.
  • General anesthesia is required.
  • You'll need to stay in the hospital for 4-to-6 days.
  • You may experience short-term facial paralysis and balance problems.
  • In some instances, hearing can’t be saved.
  • It will take 4-to-6 weeks to fully recover your strength and balance.