Acoustic Neuroma Removal

(Neurilemmoma; Vestibular Schwannoma)

Definition

An acoustic neuroma is a 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

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There are three main treatment options for an acoustic neuroma:

This fact sheet focuses on microsurgical removal.

Reasons for Procedure    TOP

  • 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    TOP

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

  • Hearing loss
  • Excessive eye dryness
  • Difficulty with balance
  • Ringing in your ears known as 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    TOP

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 medications. You may be asked to stop taking some medications up to one week before the procedure. These may include:

  • Anti-inflammatory medication
  • Blood thinners
  • Anti-platelet medication

Anesthesia

General anesthesia will be used. You will be asleep.

Description of the Procedure    TOP

The type of procedure will depend on your condition. 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 in the 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    TOP

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

How Long Will It Take?    TOP

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?    TOP

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

Average Hospital Stay    TOP

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

Post-procedure Care    TOP

At the Hospital

During recovery, you may have some of the following:

  • Head discomfort
  • Fatigue and sleepiness
  • Emotional lows
  • Headache
  • Lightheadedness
  • 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 medications 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    TOP

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 medications 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 medications 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:

Acoustic Neuroma Association
http://www.anausa.org
American Academy of Audiology
http://www.audiology.org

CANADIAN RESOURCES:

Canadian Academy of Audiology
http://www.canadianaudiology.ca
The College of Family Physicians of Canada
http://www.cfpc.ca

References:

Acoustic neuroma. American Hearing Research Foundation. Available at:
...(Click grey area to select URL)
Accessed June 25, 2013.
Acoustic neuroma. Vestibular Disorders Association. Available at:
...(Click grey area to select URL)
Accessed June 25, 2013.
Bennett M, Haynes DS. Surgical approaches and complications in the removal of vestibular schwannomas. Otolaryngol Clin North Am. 2007;40(3):589-609.
Vestibular schwannoma. EBSCO DynaMed website. Available at:
...(Click grey area to select URL)
Updated June 19, 2013. Accessed June 25, 2013.
What is acoustic neuroma? Acoustic Neuroma Association website. Available at:
...(Click grey area to select URL)
Accessed June 25, 2013.
6/2/2011 DynaMed's Systematic Literature Surveillance.
...(Click grey area to select URL)
Mills E, Eyawo O, et al. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis.Am J Med. 2011;124(2):144-154.e8.
Last reviewed June 2013 by Marcin Chwistek, MD; Michael Woods, MD
Last Updated: 5/11/2013