• 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
    Nucleus factsheet image
    Copyright © Nucleus Medical Media, Inc.
    There are three main treatment options for an acoustic neuroma:
    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.

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