Materiały źródłowe

• #1 Acoustic neuroma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acoustic-neuroma/diagnosis-treatment/drc-20356132

  Surgical removal of the tumor by an experienced neurosurgeon is one of many acoustic neuroma treatment options at Mayo Clinic. […] Your acoustic neuroma treatment may vary, depending on: The size and growth rate of the acoustic neuroma. Your overall health. Your symptoms. […] There are three treatment approaches for acoustic neuroma: monitoring, surgery or radiation therapy. […] You may need surgery to remove an acoustic neuroma, especially if the tumor is: Continuing to grow. Very large. Causing symptoms. […] The goal of surgery is to remove the tumor and preserve the facial nerve to prevent paralysis of muscles in your face. […] Surgery for an acoustic neuroma is performed under general anesthesia. […] Complications may include: Hearing loss. Facial weakness or numbness. […] Stereotactic radiosurgery technology uses many small gamma rays to deliver a precise dose of radiation to the target.

• #1 Acoustic neuroma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acoustic-neuroma/diagnosis-treatment/drc-20356132

  A type of radiation therapy known as stereotactic radiosurgery can treat an acoustic neuroma. […] The goal of stereotactic radiosurgery is to stop the growth of a tumor, preserve the facial nerve’s function and possibly preserve hearing. […] In addition to treatment to remove or stop the growth of the tumor, supportive therapies can help. Supportive therapies address symptoms or complications of an acoustic neuroma and its treatment, such as dizziness or balance problems. […] Supportive care including balance therapy, physical therapy, occupational therapy and hearing assistance is part of the comprehensive acoustic neuroma treatment at Mayo Clinic.

• #2 Acoustic Neuroma (Vestibular Schwannoma): Symptoms

  https://my.clevelandclinic.org/health/diseases/16400-acoustic-neuroma

  Acoustic neuromas (vestibular schwannomas) are benign (noncancerous) tumors that can affect the nerves that help you hear and maintain your balance. The tumors can grow large enough to be life-threatening by pressing on the part of your brain that manages the flow of spinal fluid. Treatment includes stereotactic radiosurgery and microsurgery. […] Treatment may include surgery, radiation therapy and, in rare cases, chemotherapy to treat the tumor. […] Treatment options include: […] Observation: If tests show the tumor isnt growing and you have no symptoms, your provider may recommend observation. Theyll do regular MRIs to look for changes. […] Stereotactic radiosurgery: This therapy targets tumors with beams of radiation focused on the tumor while limiting the impact on nearby healthy tissue.

• #2 Acoustic Neuroma (Vestibular Schwannoma): Symptoms

  https://my.clevelandclinic.org/health/diseases/16400-acoustic-neuroma

  Microsurgery: Neurosurgeons use special instruments that let them do surgery in very small areas of your body. This is the only treatment that can eliminate an acoustic neuroma. […] Chemotherapy: In rare cases, providers may use the chemotherapy drug bevacizumab (Alymsys, Avastin, MVASI, Zirabeva). This drug may shrink tumors, which increases the amount of time that children with acoustic neuroma will be able to hear. […] Vestibular rehabilitation therapy: Sometimes, surgery involves removing parts of nerves that control balance. Vestibular rehabilitation is therapy that helps you compensate for losing those nerves and the functions they manage. […] Your care team will discuss possible post-surgical complications and how to treat and manage them. Issues that may arise after surgery include:

• #3 EANO guideline on the diagnosis and treatment of vestibular schwannoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6954440/

  The level of evidence to provide treatment recommendations for vestibular schwannoma is low compared with other intracranial neoplasms. Therefore, the vestibular schwannoma task force of the European Association of Neuro-Oncology assessed the data available in the literature and composed a set of recommendations for health care professionals. Current treatment options include observation, surgical resection, fractionated radiotherapy, and radiosurgery. The choice of treatment depends on clinical presentation, tumor size, and expertise of the treating center. In small tumors, observation has to be weighed against radiosurgery, in large tumors surgical decompression is mandatory, potentially followed by fractionated radiotherapy or radiosurgery. Except for bevacizumab in neurofibromatosis type 2, there is no role for pharmacotherapy.

• #4 Acoustic Neuroma Treatment | Vestibular Schwannoma | Duke Health

  https://www.dukehealth.org/treatments/ear-nose-and-throat/acoustic-neuroma

  Duke experts regularly treat rare, noncancerous growths called acoustic neuromas (also called vestibular schwannomas) found on the nerves responsible for balance and hearing. Preserving your hearing and balance, avoiding or minimizing facial paralysis, and reducing your pain are equally important goals. We continually evaluate how to maximize your quality of life during and after acoustic neuroma treatment. […] Acoustic neuroma treatment involves a team of specialists, including neurosurgeons, otolaryngologists, otologists and neurotologists (specialized ear, nose, and throat doctors who complete an additional two years of training to treat ear disorders), and radiation oncologists, among others. This team works closely with you to create an individualized treatment plan that addresses your unique situation and needs.

• #4 Acoustic Neuroma Treatment | Vestibular Schwannoma | Duke Health

  https://www.dukehealth.org/treatments/ear-nose-and-throat/acoustic-neuroma

  More comprehensive treatments to address the tumor itself include: […] Lateral Skull Base Surgery. The best hospitals for acoustic neuroma surgery have surgeons like ours who are specifically trained and highly experienced in removing acoustic neuromas. […] Radiation Therapy. Image-guided radiation therapy, including stereotactic radiosurgery, targets the tumor while preserving healthy brain tissue. […] Medication. Medications are sometimes used in conjunction with radiation therapy or surgery. […] Beyond treating the tumor itself, we have a wide range of options to treat the possible symptoms of an acoustic neuroma, including hearing loss, balance problems, and facial weakness or facial paralysis. […] Vestibular Rehabilitation Therapy. This special form of physical therapy trains your body and brain to make up for inner-ear dysfunction, helps you feel steadier on your feet, and relieves or reduces disabling symptoms. […] Facial Reanimation Surgery. This surgery may be recommended if you experience total or near-total loss of your ability to show facial expression.

• #5 Acoustic Neuroma Symptoms, Surgery and Treatment | UPMC

  https://www.upmc.com/services/neurosurgery/brain/conditions/brain-tumors/acoustic-neuroma

  Acoustic neuroma (vestibular schwannoma) services at UPMC include multidisciplinary care consisting of neurosurgery, otolaryngology, neurotology and skull base surgery, neurology (otoneurology), radiation oncology, medical oncology, audiology, and vestibular physical therapy. We approach acoustic neuromas with a patient-centered care model presenting the best evidence management, including observation, microsurgery, and stereotactic radiosurgery. […] Depending on the exact location of the acoustic neuroma, the UPMC Acoustic Neuroma Center offers several microsurgical approaches, endoscopic assisted approaches, as well as Gamma Knife radiosurgery. […] The UPMC Acoustic Neuroma Center offers a wide array of treatment options for acoustic neuromas. Our multidisciplinary team of neurosurgeons and neurotologists works together to offer each patient a personalized treatment plan. Treatment for acoustic neuroma depends on your age and general health, as well as the tumor’s size, location, and rate of growth.

• #5 Acoustic Neuroma Symptoms, Surgery and Treatment | UPMC

  https://www.upmc.com/services/neurosurgery/brain/conditions/brain-tumors/acoustic-neuroma

  If the patient is experiencing more serious symptoms, surgery may be recommended by the doctor. […] As the acoustic neuroma grows, or if hearing becomes impaired, removal of all or part of the tumor may be necessary. […] Microsurgical approaches for acoustic neuromas, all available at the UPMC Acoustic Neuroma Center, include: Retrosigmoid approach, Translabyrinth approach, Middle fossa approach, Endoscopic-assisted retromastoid approach. […] The experts at the UPMC Acoustic Neuroma Center may recommend a combination of surgical and non-surgical treatments to treat your acoustic neuroma. Our goal is to maximize the benefits of surgery, while minimizing risks. […] Gamma Knife may be the first treatment option for an acoustic neuroma, particularly in cases where the tumor is not causing mass effect. […] Gamma Knife may be used as an additional treatment after partial surgical removal for large acoustic neuromas. UPMC doctors use this treatment to prevent further growth of the tumor and maintain current neurological and hearing functions.

• #6 Acoustic Neuroma Treatment | Vestibular Schwannoma | Rush

  https://www.rush.edu/services/acoustic-neuroma-care

  As the only dedicated acoustic neuroma program in Chicago, Rush experts ensure you receive the most effective, advanced treatments. […] The Rush Acoustic Neuroma Program offers personal care plans for patients with acoustic neuromas. The program brings together highly skilled specialists who have extensive experience diagnosing and treating these tumors, including the following: Neurotologists (a subspecialty within ENT), Neurosurgeons, Neuro-oncologists, Radiation oncologists, Audiologists, Facial plastic and reconstructive surgeons. […] There are three general approaches for managing acoustic neuromas. They include the following: Observation: Because acoustic neuromas can now be found when they’re very small with MRI scans and tend to grow very slowly or not at all, our team may just observe the tumor over time. If they see any concerning changes, they may address them with further treatment in the future. Surgery: If a tumor is already large, growing quickly or causing symptoms, the team may choose to surgically remove it. The surgery is very effective and can stop the progression of hearing loss and reduce or stop other symptoms. Stereotactic radiosurgery: In some cases, low-dose radiation therapy can slow or stop the growth of tumors, though it does not remove them. This treatment uses focused radiation to target the tumor without damaging surrounding tissue.

• #6 Acoustic Neuroma Treatment | Vestibular Schwannoma | Rush

  https://www.rush.edu/services/acoustic-neuroma-care

  Your team of specialists will provide input and work with you to decide on the best approach for treatment. […] It’s important to consult with an acoustic neuroma specialist to learn about all your options before you start any type of treatment. […] The first line of treatment for acoustic neuroma will vary based on your individual condition. But your care team will always work to recommend the least invasive approaches that will be effective. In some cases, this may only involve monitoring a tumor’s growth. Others will need surgery. […] Yes, a full recovery is possible after treatment. Your recovery and how long it takes will vary, but your care team will help you understand your condition and options. They can connect you with rehabilitation services for follow-up care if needed. […] For our acoustic neuroma patients, we work in a collaborative fashion with the departments of neurosurgery and radiation oncology to offer you a full array of treatment options.

• #7 Acoustic Neuroma Treatment & Surgery (Vestibular Schwannoma)

  https://health.ucsd.edu/care/ent/acoustic-neuroma/treatment/

  When it comes to treatment, you have options. Some patients choose to monitor their tumor if its small, while others opt for radiation or surgery to address symptoms. Your care team will help you decide whats best for you. […] Surgery may be recommended if your tumor is large, growing, or causing significant symptoms. […] A wait and watch approach might be recommended if your tumor is small (less than 2 cm) and causing few or no symptoms. […] In general, radiation works by targeting and altering the DNA inside your cells, which can stop tumor growth or destroy the tumor cells altogether. […] Radiation is a nonsurgical treatment often performed in an outpatient setting. […] Gamma Knife radiosurgery, which is very precise and non-invasive, is typically completed in one session. […] We have extensive experience with all three surgical approaches to remove acoustic neuromas.

• #8 Acoustic Neuroma Treatment & Management: Medical Therapy, Surgical Therapy, Preoperative Considerations

  https://emedicine.medscape.com/article/882876-treatment

  Acoustic neuromas are managed in one of the following three ways: (1) surgical excision of the tumor, (2) arresting of tumor growth using stereotactic radiation therapy, or (3) careful serial observation. […] Intervention is indicated when tumors exhibit significant growth, which is generally considered greater than 2 mm per year. Options include either microsurgery or radiosurgery, and optimal therapy is dependent on such factors as tumor size, patient age, and hearing status. […] Stereotactic radiosurgery has emerged as an alternative to microsurgery for selected patients with acoustic neuroma. Stereotactic radiation therapy makes use of one of several radiation sources and is administered using a variety of different machines with proprietary names (eg, Gamma Knife, CyberKnife, Brainlab).

• #8 Acoustic Neuroma Treatment & Management: Medical Therapy, Surgical Therapy, Preoperative Considerations

  https://emedicine.medscape.com/article/882876-treatment

  The goal of radiotherapy is to arrest tumor growth, and patients will need to be monitored with MRI scans after treatment to assess for any changes in tumor size. […] A study by Boari et al of patients with an acoustic neuroma found Gamma Knife radiotherapy for these tumors to be safe and effective, providing control in 97.1% of the study’s patients and tumor volume reduction in 82.7% of them; the mean relative volume reduction in the latter group was 34.1%. […] Microsurgical removal remains the treatment of choice for tumor eradication. […] A prospective, observational study by Nellis et al indicated that in patients with acoustic neuroma, those most likely to pursue treatment with surgical resection rather than active surveillance are persons under age 65 years with medium-to-large tumors; growing tumors; significant hearing loss; and higher headache severity scores.

• #9 Vestibular schwannoma (acoustic neuroma) | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/brain-tumour/acoustic-neuroma

  You will need to give permission (consent) for the hospital staff to give you the treatment. […] How treatment might affect your hearing varies depending on the type of treatment and your individual situation. […] The aim of any treatment is to control the tumour and stop it growing or remove it. […] If hearing has already been lost, treatment is not able to improve hearing. If you still have some hearing, treatment may be able to preserve hearing. […] Active monitoring means regularly checking the tumour to find out whether it is growing. […] If the tumour is small, your doctor may suggest monitoring the tumour for growth. […] Some treatment can cause side effects and some of these may be permanent. […] Radiotherapy uses high-energy rays to destroy the tumour cells. […] You may have radiotherapy to stop a tumour growing. Sometimes it can also shrink it.

• #9 Vestibular schwannoma (acoustic neuroma) | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/brain-tumour/acoustic-neuroma

  A vestibular schwannoma is usually treated with a type of radiotherapy called stereotactic radiotherapy (SRT). […] Your specialist doctor will explain how long treatment will last and the type of radiotherapy you will have. […] Surgery for a vestibular schwannoma involves removing all or part of the tumour. […] Your surgeon will explain the type of surgery and the possible risks. […] After surgery, you may have headaches, nausea, feel dizzy, or notice that your balance is affected. […] Surgery may cause hearing loss in the affected ear. […] Sometimes, surgery can damage the facial nerve on the side of the face affected. […] After your treatment has finished, you will have regular check-ups, tests and scans. […] Your doctor or nurse may refer you to a neurological rehabilitation service.

• #10 Acoustic Neuroma | Brain Tumor Center | Stanford Medicine

  https://med.stanford.edu/brain-tumor/conditions/acoustic-neuroma.html

  Stanford Brain Tumor Center is a global referral center for the diagnosis and treatment of acoustic neuromas. Treatments for acoustic neuromas include various approaches to surgery, stereotactic radiosurgery (SRS), radiation therapy, or a combination of surgery, stereotactic radiosurgery, and radiation therapy. A type of radiation treatment developed here at Stanford, known as CyberKnife, is often used to treat acoustic neuromas. […] Your doctor will guide you through the options to help you decide what is best for you. We also offer an active clinical research program dedicated to broadening options for the diagnosis and treatment of acoustic neuromas. […] Join us to learn about the latest treatment options, network with other meningioma patients, and find encouragement and support. Family members, caregivers, friends and interested persons are encouraged to attend. No registration necessary.

• #11 Acoustic Neuroma Diagnosis & Treatment – NYC | Columbia Neurosurgery in New York City

  https://www.neurosurgery.columbia.edu/patient-care/conditions/acoustic-neuroma

  An acoustic neuroma is a tumor in the lining of the nerve that connects the inner ear with the brain. On the basis of each patients individual needs, the neurosurgeons at Columbias Skull Base Tumor Center choose among the treatment options: observation, stereotactic radiotherapy or surgical removal. […] Various treatment options exist for acoustic neuroma. Our neurosurgeons can help patients decide on the best treatment plan on an individual basis: observation, stereotactic radiotherapy, or surgical removal. […] Observation may be appropriate for small tumors that dont cause symptoms. Patients and surgeons may also choose observation when the patients age or general health increases the risks of surgery. […] Stereotactic radiosurgery may be appropriate for some tumors. This treatment uses highly focused beams of radiation to disrupt the tumors growth. Unlike conventional surgery, it does not require an incision, and patients are generally able to return to normal life quickly after the procedure. However, it may take months or years to see the full effect of radiosurgery. Regular follow-up scans are required.

• #12 Expert guidance for vestibular schwannomas’ complex treatment decisions – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/neurology-neurosurgery/news/expert-guidance-for-vestibular-schwannomas-complex-treatment-decisions/mac-20534886

  Expert guidance for vestibular schwannomas’ complex treatment decisions […] „We’re now prioritizing functional outcomes over a definitive cure,” says Michael J. Link, M.D., a neurosurgeon at Mayo Clinic in Rochester, Minnesota. „There are multiple reasonable treatment options, and patient preference plays a major role in shared decision-making.” […] „Depending on the individual patient and tumor, the strategies include a wait-and-scan approach, irradiation, microsurgery, or a combination of these methods,” Dr. Link says. „Each strategy has advantages and limitations. Data show that quality of life is affected more by the diagnosis itself and patient-related factors than by the actual treatment choice.” […] „Hearing loss is likely to progress with this approach, even if the tumor doesn’t grow,” Dr. Link says.

• #12 Expert guidance for vestibular schwannomas’ complex treatment decisions – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/neurology-neurosurgery/news/expert-guidance-for-vestibular-schwannomas-complex-treatment-decisions/mac-20534886

  Among individuals with small tumors, 40% to 70% retain serviceable hearing after microsurgery. For tumors larger than 2.5 cm, the probability of preserving serviceable hearing after surgery is less than 5%. Total resection of large tumors also risks permanent partial or complete facial nerve paralysis. […] To minimize those complications, a tumor remnant might be left around the facial nerve and brainstem. About 30% of tumors regrow to some degree after subtotal tumor resection. As described in a study published in the August 2021 issue of Acta Neurochirurgica, Mayo Clinic usually treats residual tumors with adjuvant radiosurgery.

• #12 Expert guidance for vestibular schwannomas’ complex treatment decisions – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/neurology-neurosurgery/news/expert-guidance-for-vestibular-schwannomas-complex-treatment-decisions/mac-20534886

  If tumor growth is confirmed, Mayo Clinic generally recommends radiosurgery or microsurgery. Radiosurgery is reserved for tumors measuring less than 2.5 cm. The options include Gamma Knife radiosurgery which Mayo Clinic has performed for more than 30 years as well as intensity-modulated therapy and proton therapy. […] „Radiosurgery doesn’t cure the tumor. The goal is to prevent tumor growth,” Dr. Link says. „Between 50% and 70% of patients retain serviceable hearing in the treated ear.” […] Microsurgery is the treatment of choice for large tumors associated with complications such as brainstem compression, hydrocephalus, trigeminal neuralgia or neuropathy. The procedure is performed with an operating microscope and intraoperative neural monitoring. […] „The goal is maximal tumor removal with preservation of neurological function,” Dr. Link says.

• #13 EANO guideline on the diagnosis and treatment of vestibular schwannoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6954440/

  Observing VS is considered appropriate for incidental, asymptomatic VS. As an alternative to observation, SRS can be performed. […] For smaller VS where preserving facial nerve and hearing function is the primary goal of treatment, SRS over microsurgery may be chosen. […] In large VS surgery is considered as the primary treatment to reduce mass effect. The choice of surgical approach depends on tumor characteristics and surgeons expertise. Intraoperative neurophysiological monitoring is mandatory. […] For large VS, tumor mass reduction followed by SRS or observation is a valid option. […] Surgical management of VS should take into account tumor size and morphology at time of diagnosis as well as the patients symptoms, comorbidities, and preferences. […] The choice of surgical approach depends on hearing status, tumor characteristics, patients preferences, and surgeons expertise. The experience of the surgical team is an important factor affecting the outcome, suggesting that VS should be treated in high volume centers.

• #13 EANO guideline on the diagnosis and treatment of vestibular schwannoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6954440/

  Goal of surgery should be total or near-total resection, since residual tumor volume correlates with rate of recurrence. […] For large VS, the lower risk of recurrence after GTR should be weighed against the higher risk for facial nerve dysfunction and lower rates of hearing preservation, since there seems to be a relationship between tumor volume and functional outcome. […] Stereotactic radiosurgery defines delivery of high dose irradiation with high conformity and precision in a single fraction and is commonly used for small to medium sized VS. […] Five prospective studies without randomization have revealed that SRS is superior to microsurgery for patients with VS 3 cm in terms of preserving facial nerve and hearing function. […] The recommendation is to use SRS with a dose of 11-14 Gy at the margin and 11-12 Gy when the risk of hearing loss is a critical issue. […] Bevacizumab has been successfully used for patients with progressive VS associated with NF2.

• #14 Acoustic Neuroma (Vestibular Schwannoma) – UC Health

  https://www.uchealth.com/en/conditions/acoustic-neuroma

  Acoustic neuroma treatment may vary, depending on the size and growth of the acoustic neuroma, the patients overall health, and if the patient is experiencing symptoms. To treat an acoustic neuroma, your doctor may suggest one or more of three potential treatment methods: monitoring (observation), surgery, or radiation therapy. […] If you have a small acoustic neuroma that isn’t growing or is growing slowly and causes few or no signs or symptoms, the physician may decide to monitor it, especially if the patient is an older adult or otherwise not a good candidate for surgery. […] The physician may recommend surgery to remove an acoustic neuroma. The surgeon may use one of several techniques for removing an acoustic neuroma, depending on the size of the tumor, hearing status, and other factors.

• #15 Acoustic Neuroma (Vestibular Schwannoma) | University of Michigan Health

  https://www.uofmhealth.org/conditions-treatments/ear-nose-throat/acoustic-neuroma

  Middle Fossa approach: A hearing preservation approach used for patients with good hearing and smaller tumors that are primarily located within the internal auditory canal. This procedure is used in situations where hearing preservation is possible. […] Retrosigmoid approach: Used for small- to moderate-sized acoustic neuromas that are growing beyond the internal auditory canal and near the brainstem. This procedure is also used for patients where hearing preservation is possible, although the chance for hearing preservation decreases with larger tumors. […] Translabyrinthine approach: Used for any size tumor that has caused significant hearing loss, or where hearing preservation is not possible due to tumor size. This procedure results in complete hearing loss on the tumor side, but offers the best chance for facial nerve preservation in such patients.

• #15 Acoustic Neuroma (Vestibular Schwannoma) | University of Michigan Health

  https://www.uofmhealth.org/conditions-treatments/ear-nose-throat/acoustic-neuroma

  At Michigan Medicine, each patient is thoroughly evaluated, with a complete history, a physical examination, MRI or CT imaging and hearing and balance tests. We take into consideration health issues, the size and location of the tumor and its symptoms, and then discuss all treatment options with the patient. […] Treatment options include: […] Observation: This method is typically an option for small tumors or tumors with no accompanying symptoms as well as for patients who are elderly or too ill for surgery. […] Stereotactic radiosurgery: In select cases, this radiation treatment can control tumors using precisely targeted X-ray beams. This type of advanced technique makes it possible to send radiation to the tumor while limiting exposure/damage to surrounding tissue. […] Microsurgery, which includes three potential approaches:

• #15 Acoustic Neuroma (Vestibular Schwannoma) | University of Michigan Health

  https://www.uofmhealth.org/conditions-treatments/ear-nose-throat/acoustic-neuroma

  Publications over the last two decades from the University of Michigan report high rates of success with preservation of hearing when the middle fossa approach was used to remove small to moderate size tumors. Of the people in the study who had useful hearing before the surgery, over three-quarters retained a level of useful hearing after their tumors were removed. The results published in this study represent the highest hearing preservation rates published to date.

• #16 Surgery for Acoustic Neuroma (Vestibular Schwannoma) | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/acoustic-neuroma/treatment/surgery-acoustic-neuroma

  Retrosigmoid approach (also known as the retromastoid approach or the suboccipital approach). This involves an incision behind the ear and removal of bone to expose the tumor. It can be used for any size tumor and, in patients with small tumors, can sometimes preserve hearing. […] Translabyrinthine approach. This involves an incision behind the ear and removal of bone, including a portion of the inner ear structures. This technique gives the surgeon excellent access to the tumor. It leads to total deafness, but many patients with acoustic neuromas have already lost their hearing. […] Middle fossa approach (also known as the subtemporal approach). This technique is intended for small tumors in patients with good hearing. It is achieved through an incision above the ear and bone removal to access the tumor.

• #16 Surgery for Acoustic Neuroma (Vestibular Schwannoma) | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/acoustic-neuroma/treatment/surgery-acoustic-neuroma

  Your team of surgeons at MSK will recommend which approach is best for your particular tumor. […] Throughout an operation to remove an acoustic neuroma, surgeons use sophisticated monitoring techniques to minimize the risk to the nerves in the region and to the brain. […] Surgery for acoustic neuromas involves collaboration between neurosurgeons and neurotologists (skull-base surgeons who specialize in the inner ear, the bones of the side and back of the skull, and the lower cranial nerves and brain stem).

• #17 Vestibular schwannoma, acoustic neurinoma | Inselspital Bern

  https://neurochirurgie.insel.ch/en/what-we-treat/brain-tumor/vestibular-schwannoma

  Treatment is based primarily on the size of the tumor, its growth behavior, and the patient’s symptoms. An optimal, individualized treatment recommendation for each patient is made at Inselspital by the interdisciplinary Tumor Board. Each patient’s case is discussed by specialists from neurosurgery, radiation oncology, otolaryngology, oncology, and neuroradiology. […] According to the modern concept, preserving the facial nerve function has priority over complete tumor resection. Even in the best hands, the rate for severe facial paralysis in complete removal of large tumors is more than 20%, according to the results in the international literature. Therefore, surgery is supported by special intraoperative neuromonitoring and is usually already planned as subtotal surgery. Also in case of incomplete facial paresis, the possible functional and cosmetic deficits weigh much more heavily than the slow, often absent growth of a small residual tumor.

• #17 Vestibular schwannoma, acoustic neurinoma | Inselspital Bern

  https://neurochirurgie.insel.ch/en/what-we-treat/brain-tumor/vestibular-schwannoma

  In some patients, a small tumor remnant must be left to preserve the auditory or facial nerve functions. This tumor remnant can be followed up later with radiosurgery if necessary. […] Radiosurgery is a highly focused and high-dose single radiation treatment representing a treatment alternative to open surgery for small, well-defined tumors. […] In some instances, it makes sense to use microsurgery and radiosurgery in combination. This is the case, for example, if a relevant tumor remnant is still present after microsurgery or if a tumor that has already been operated on has grown again. […] Particularly in patients with bilateral vestibular schwannomas, low-dose drug therapy with Avastin (bevacizumab) may be attempted to halt tumor growth and preserve hearing function for as long as possible.

• #17 Vestibular schwannoma, acoustic neurinoma | Inselspital Bern

  https://neurochirurgie.insel.ch/en/what-we-treat/brain-tumor/vestibular-schwannoma

  In the case of a KOOS III or IV tumor, immediate treatment is indicated. In this case, microsurgical tumor removal is usually preferable to radiosurgery in order to reduce the compressive effect on the surrounding tissue. […] Neurosurgical resection of vestibular schwannoma is usually performed through a skin incision behind the ear, the retrosigmoid approach. Surgery is performed with a surgical microscope under high magnification. The risk of postoperative hearing loss depends mainly on the tumor size and pre-existing hearing loss. […] To reduce the risk of cranial nerve injury during surgery, special neurophysiological monitoring is performed as standard at Inselspital. This involves monitoring auditory function, the facial nerve, the swallowing nerve, and other cranial nerves, and the motor pathway and sensitive fibers during surgery.

• #18 Vestibular schwannoma – Wikipedia

  https://en.wikipedia.org/wiki/Vestibular_schwannoma

  The 'Patient Survey’ in the U.S. in 2014 by the national Acoustic Neuroma Association showed that 29% of VS patients reported radiosurgery (17%) or radiotherapy (12%) as their treatment of choice. Radiosurgery is the delivery to the VS of a concentrated high radiation dose in a one-day session, whereas radiotherapy involves multiple treatment sessions where the total radiation dose is spread out in fractions over a few days or 34 weeks. The main objective in either case is 'tumor control’ by damaging tumor cell DNA and stopping blood vessel proliferation (angiogenesis) needed for tumor growth. […] The overall mortality rate for VS surgery is around 0.2% – 0.5%. The most common complications include facial nerve disorder (25.0%), cerebrospinal fluid leakage (8.5%) and postoperative neurological complications (8.4%).

• #18 Vestibular schwannoma – Wikipedia

  https://en.wikipedia.org/wiki/Vestibular_schwannoma

  To date, there is no fully efficacious medical therapy for VS. The complexity of the molecular biology research involved is truly challenging. Clinical trials are in progress for other drugs such as everolimus, lapatinib and mifepristone. Common aspirin has been studied as a low-risk therapeutic option, but emerging evidence suggests that aspirin and other NSAID use may not prevent VS tumor growth. […] The 1991 NIH Consensus Statement observed: „There is evidence that some patients with unilateral vestibular schwannoma and a subgroup of patients with NF2 may have tumors that fail to progress rapidly, resulting in stable neurologic function for a long time. The use of MRI with contrast enhancement has resulted in the identification of patients with very small, relatively asymptomatic vestibular schwannomas for whom the natural history is unknown. Conservative management may be appropriate for these patients.”

• #18 Vestibular schwannoma – Wikipedia

  https://en.wikipedia.org/wiki/Vestibular_schwannoma

  The 1991 NIH Consensus Statement recommended attention to „the development of pharmaceutical and other alternative medical treatments, such as tumor suppressing agents.” Ideally, a drug could be found to permanently shrink or eradicate VSs, with minimal side effects. A key step forward in 1993 was the identification of the NF2 gene and its protein product Merlin, which modulates the complex molecular signaling pathways that control cell proliferation. These pathways that drive VS formation (tumorigenesis) and growth are currently under investigation.

• #19 Vestibular Schwannoma Treatments | Targeting Cancer AU & NZ

  https://www.targetingcancer.com.au/treatment-by-cancer-type/vestibular-schwannoma/

  Vestibular schwannomas (Acoustic Neuroma) are non-cancerous growths along the nerve that joins the inner ear to the brain. […] The best person to talk to about radiation therapy for vestibular schwannomas is a radiation oncologist. […] You can ask your doctor for a referral to a radiation oncologist to learn if radiation therapy is an option for you. […] The type of treatment a person gets is worked out by a team of doctors and health professionals often called a Multidisciplinary Team. […] A highly trained radiation oncology team takes care of people having radiation therapy. […] There are a few ways to treat vestibular schwannomas. These include observation, surgery, or radiation therapy. […] If the schwannoma is small, the doctor may recommend a watch and wait approach. […] For larger schwannomas and younger people, surgery is preferred.

• #19 Vestibular Schwannoma Treatments | Targeting Cancer AU & NZ

  https://www.targetingcancer.com.au/treatment-by-cancer-type/vestibular-schwannoma/

  Radiation therapy can be used to treat vestibular schwannoma. The aim of treatment is to stop the tumour growing and protect the nerve. […] Stereotactic radiosurgery is when high-energy x-ray beams are focused precisely on the tumour. […] Stereotactic radiation therapy is like SRS, but treatment is done over 3 to 5 sessions, rather than one. […] Fractionated stereotactic radiation therapy is the same as stereotactic radiation therapy but doctors deliver small doses of radiation (fractions) each day over 5-6 weeks. […] Radiation therapy is very effective for treating vestibular schwannomas. […] Stereotactic treatments have success rates of between 91 to 100% 10 years after treatment. […] Before starting treatment, your radiation oncologist will talk to you about side effects and answer your questions.

• #19 Vestibular Schwannoma Treatments | Targeting Cancer AU & NZ

  https://www.targetingcancer.com.au/treatment-by-cancer-type/vestibular-schwannoma/

  The side effects of radiation treatment for Vestibular Schwannomas can be split into 2 groups: Early side effects which occur during and shortly after radiation treatment. […] Late side effects which can occur months to years after radiation treatment. […] The long-term side effects of radiation therapy for vestibular schwannoma can happen months or years after treatment and may include: Damage to cranial nerve, Tumour growth, Hearing loss, Second cancer. […] You can ask your Surgeon or General Practitioner for a referral to a Radiation Oncologist for a discussion about whether radiation therapy is a suitable treatment option for you. […] The best person to talk to is a radiation oncologist. You can ask your doctor for a referral to find out if radiation treatment is right for you.

• #20 Contemporary Management of Vestibular Schwannoma | AAO-HNS Bulletin

  https://bulletin.entnet.org/clinical-patient-care/article/22834080/contemporary-management-of-vestibular-schwannoma

  Stereotactic radiosurgery (SRS) was popularized by Leksell in the 1960s with the advent of the Gamma Knife system. SRS refers to the delivery of ionizing radiation in a single fraction (or sometimes two). Stereotactic radiotherapy (SRT) refers to the delivery of radiation to the tumor in multiple fractions. Most centers deliver 12-13 Gy using SRS or SRT paradigms to the tumors with the goal of arresting tumor growth. […] SRS/SRT should not be considered a hearing-sparing treatment option for most patients. Greater than 60% of patients will lose serviceable hearing after SRS/SRT within 6 years even if they had serviceable hearing prior to treatment and had the cochlear dose limited to less than 3 Gy. […] Microsurgical tumor resection may be performed on any tumor, through translabyrinthine (TL), retrosigmoid (RS), or middle fossa approaches, depending on hearing status and tumor extent.

• #20 Contemporary Management of Vestibular Schwannoma | AAO-HNS Bulletin

  https://bulletin.entnet.org/clinical-patient-care/article/22834080/contemporary-management-of-vestibular-schwannoma

  Once identified, a thorough discussion of treatment options is warranted. Patients may be offered a wait and scan approach, stereotactic radiotherapy, or open microsurgery. In general, the factors that will affect the initial treatment recommendation are tumor size, hearing status, and patient age, in addition to patient preference. […] The management of VS has dramatically changed as the understanding of the natural history of these tumors has become better. […] This watchful waiting may be a good choice for patients with small tumors and excellent hearing in the ipsilateral ear; patients over age 65 or medically frail patients may also benefit from this approach. […] Preservation of hearing function is another commonly expressed reason for opting for serial imaging. […] Although there is technically no upper size limit for observation with serial imaging, significant posterior fossa symptoms including brain stem impaction and certainly compression would push most patients toward intervention.

• #21 Acoustic Neuroma Diagnosis & Treatment NYC | Mount Sinai – New York

  https://www.mountsinai.org/locations/skull-base-surgery-center/conditions/acoustic-neuroma

  Stereotactic radiation: Acoustic neuromas can be treated by a specialized form of radiation, called stereotactic radiotherapy (“radiosurgery”). […] In properly selected patients, radiotherapy is effective in freezing tumor growth with rapid recovery and return to work. […] A Comparison of Surgery versus Stereotactic Radiation […] Tumor removed completely […] Tumor still present, but usually freezes growth. […] Long-term cure in most, re-growth uncommon […] Re-growth can occur; long-term results uncertain […] Hospitalization […] No hospitalization […] Facial nerve weakness can occur […] Facial nerve weakness uncommon, usually temporary […] Hearing loss may occur, but hearing preservation possible in select cases […] Hearing often declines within a few years after treatment […] Dizziness common in the beginning but improves over time. […] Dizziness may remain stable or worsen.

• #22 Acoustic neuroma | The Brain Tumour Charity

  https://www.thebraintumourcharity.org/brain-tumour-diagnosis-treatment/types-of-brain-tumour-adult/acoustic-neuroma-vestibular-schwannoma/

  Clinical trials are being conducted using Bevacizumab, Everolimus and Lapatinib as potential options for treating vestibular schwannomas. […] Vestibular schwannomas very rarely return after surgery, but you may continue to have regular MRI scans. […] Even with treatment, symptoms such as tinnitus and hearing loss can persist. These symptoms will require additional treatment.

• #23 Chemotherapy for Acoustic Neuroma | Aaron Cohen-Gadol, MD

  https://www.aaroncohen-gadol.com/en/patients/acoustic-neuromas/treatment/chemotherapy

  In patients with sporadic acoustic neuromas (non-hereditary), a 2014 study showed erlotinib stabilized or even reduced acoustic neuroma tumors with some patients experiencing hearing improvement over time. More studies are needed to evaluate the effectiveness of this drug before it can be recommended outside of approved clinical trials. […] Since the 2000s, initial research suggested that aspirin and other NSAIDS (non-steroidal anti-inflammatory drugs) may assist in stopping or shrinking acoustic neuroma. However, according to subsequent studies, there is no association between taking aspirin and acoustic neuroma tumor growth over time. These medications are not commonly used anymore to treat acoustic neuromas. […] At this time, there are no known home or natural remedies to prevent or treat acoustic neuromas. […] Chemotherapy is not a standard treatment for acoustic neuromas. […] Current research does not show that there are any home or natural remedies effective in preventing or treating acoustic neuromas.

• #24 Vestibular Health — Training your brain with vestibular rehab for acoustic neuroma

  https://www.vestibularhealth.ca/blog/vestibular-rehab-for-acoustic-neuroma

  Vestibular rehabilitation is an exercise based treatment delivered by specially trained physiotherapists. […] Our focus in vestibular rehab is to reduce symptoms of vertigo or dizziness, improve gaze stability, improve balance and mobility, and reduce risk of falls. […] Systematic reviews have concluded that there is moderate to strong research evidence (high quality randomized controlled trials) that vestibular rehab is a safe and effective treatment for loss of vestibular function. […] Treatment is guided by the assessment findings and your priorities. Therapy sessions are active and exercise based, and tailored to your symptoms and goals. […] Your treatment plan might also include exercises for leg strength, joint mobility, and a walking program. […] A vestibular physio may be able to help you if you have problems with dizziness or balance across any stage of diagnosis or management of vestibular schwannoma.

• #24 Vestibular Health — Training your brain with vestibular rehab for acoustic neuroma

  https://www.vestibularhealth.ca/blog/vestibular-rehab-for-acoustic-neuroma

  If you are taking a watch wait approach or are awaiting surgery or radiation, vestibular rehab can address symptoms of dizziness, and help maintain and improve your functional mobility and balance. […] After surgery, there is some research that suggests gaze stability exercises can speed up vestibular compensation, improve your balance, and help you feel less unsteady more quickly. […] If you are experiencing dizziness or balance problems after radiation, vestibular rehab can help facilitate better compensation, improve your balance and mobility, and help you get back to your usual activities. […] However, seeing an experienced vestibular physiotherapist will give you a program that is customized to your particular challenges and goals. […] It can also be helpful to have a physiotherapist on your team to check in with when you need to, as your symptoms and balance abilities can change over time with acoustic neuroma.

• #25 Vestibular Health — Vestibular schwannoma or acoustic neuroma

  https://www.vestibularhealth.ca/blog/vestibular-schwannoma-acoustic-neuroma

  After diagnosis but prior to any surgery or radiation treatment, vestibular rehabilitation physiotherapy can help decrease symptoms of dizziness, improve your balance, and maximize your physical functioning. Studies have also shown that vestibular rehabilitation before surgery limits the imbalance experienced after surgery and promotes better compensation, leading to faster recovery. […] Your vestibular physiotherapist can provide an individualized treatment program to improve symptoms of dizziness – particularly dizziness provoked by head movement, improve your gaze stability – the ability for you to keep your vision focused while you are moving around, and improve your balance. […] Physiotherapists can also provide facial neuromuscular retraining therapy if you have facial muscle weakness or synkinesis due to facial nerve involvement from this type of tumor or its treatment.

• #26 What is Acoustic Neuroma (Vestibular Schwannoma)? Symptoms, Risk Factors & Treatments | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/acoustic-neuroma.html

  Acoustic neuroma and its treatment can cause hearing loss. MD Andersons comprehensive Audiology Section helps evaluate and manage this issue. Rehabilitation services include conventional hearing aids, bone-anchored hearing aids (BAHA) or contralateral routing of sound hearing aids (CROS). Select patients may receive a cochlear implant. […] Occasionally, patients develop additional challenges after treatment for acoustic neuroma, such as facial paralysis or loss of balance. Physicians in ophthalmology, plastic and reconstructive surgery, and rehabilitation medicine are available to help manage these issues. […] We offer complete genetic testing and counseling to help determine your risk. As one of the nations top research institutions, MD Anderson is investigating new ways to treat acoustic neuroma, especially for patients with NF2.

• #27 What Are the Best Solutions for Vestibular Schwannoma-Related Hearing Loss?

  https://reports.mountsinai.org/article/ent2024-vestibular-schwannoma

  There is no single solution for treating hearing loss among patients with vestibular schwannomas (acoustic neuromas), and the ideal approach depends on unique factors involving the tumor and patient. […] The complicated decision process often starts with determining the optimal approach for treating these benign tumors among patients: observation, radiation, or surgery. […] In an ideal world, we would resect the tumor and the patients hearing would be preserved, but that may not be possible based on the tumors size and location or the level of hearing loss the patient has already experienced, Dr. Cosetti says. […] Once a determination is made as to treatment, the focus shifts to preserving or treating the patients hearing. […] For patients who retain some hearing, Dr. Cosetti typically recommends a hearing aid.

• #27 What Are the Best Solutions for Vestibular Schwannoma-Related Hearing Loss?

  https://reports.mountsinai.org/article/ent2024-vestibular-schwannoma

  For those who have experienced complete hearing loss and who do not have an intact cochlear nerve, there are a couple of options. […] For these patients, Dr. Cosetti typically recommends a bone conduction hearing aid. […] Some of the bone conduction options are nicer for patients quality of life, Dr. Cosetti says. […] Although it has been widely used for other indications of single-sided deafness, cochlear implantation has only recently been offered to patients presenting with vestibular schwannomas. […] We have found it is possible to do an implant that benefits patients so long as the cochlear nerve is intact, says Dr. Cosetti. […] Extrapolated data on single-sided deafness from a non-acoustic neuroma suggests patients experience dramatic improvements in quality of life, ability to localize sound, and ability to understand speech in noisy environments among patients who have undergone cochlear implantation. […] We know that it seems to be better when compared against bone conduction devices, she adds, but we do not know how much better, and we do not know if it is the same as with patients with a non-vestibular schwannoma.

• #28 Vestibular Schwannomas (aka acoustic neuromas) | UNC Facial Nerve Center

  https://www.med.unc.edu/ent/facialnervecenter/conditions/vestibular-schwannomas-aka-acoustic-neuromas/

  Vestibular schwannomas (aka acoustic neuromas) are managed and treated by neurotologists (dedicated ear and skull base surgeons). Treatment options include observation, targeted radiation therapy, and surgery to remove the tumor. […] Surgery and radiation therapy to treat these tumors can damage the facial nerve causing temporary, or even permanent, facial weakness. […] If no recovery has occurred after 6 months, Dr. Miller can perform a 5-7 Nerve Transfer Smile Reanimation procedure to restore a patients smile while permitting continued recovery of the native facial nerve. […] Patients are candidates for treatments such as selective denervation and Botox to restore facial symmetry and function.

• #29 Acoustic neuroma | healthdirect

  https://www.healthdirect.gov.au/acoustic-neuroma

  An acoustic neuroma is a benign (non-cancerous) tumour that grows in the acoustic nerve, the eighth cranial nerve in the brain. […] Treatment options include surgery, radiation therapy (also known as stereotactic treatment) and careful monitoring. […] The options for treatment include: 'watch and wait’ monitoring the tumour growth and related symptoms, surgery to remove the tumour, stereotactic treatment this procedure sends radiation to the tumour to stop it from growing. […] The treatment recommended for you will depend on: the size and location of the tumour, your symptoms, your age, your general health, your preferences.

• #30 Acoustic Neuromas: What You Should Know – Neurosurgery

  https://lsom.uthscsa.edu/neurosurgery/clinical-practice/treatments/acoustic-neuromas/

  Stereotactic radiosurgery has become the generally accepted first line treatment for smaller tumors and has been shown to be quite effective at controlling further tumor growth. […] Currently, patients of any age, or general medical condition may be considered candidates for radiosurgery. Certain factors will indicate that it is not the preferred form of therapy in an individual case. This is best discussed with a neurosurgeon who performs both radiosurgery and microsurgery for a balanced view of the risks of each form of treatment and the best chance of reaching treatment goals. […] Surgeons at the UT Health Science Center Center for Cranial Base Surgery are working to refine treatment strategies for patients with these tumors. Especially in the case of patients with very large tumors, a combined strategy of initial surgery to safely reduce the size of the tumor followed by Novalis Shaped-Beam surgery is ongoing and has thus far demonstrated superior facial nerve functional preservation results. […] Scientists are working on various forms of treatment for acoustic neuromas that do not involve either surgery or stereotactic radiosurgery. The development of gene therapy may hold the most promise for a future cure of these tumors without surgery.

• #31 Collaboration Brings Best Treatment Options for Acoustic Neuroma – Cedars-Sinai Pulse

  https://pulse.cedars-sinai.org/news/collaboration-brings-best-treatment-options-for-acoustic-neuroma

  This research aims to support additional testing and animal models to develop new therapies and medications. […] The pair is also working on immunotherapy that would target acoustic neuromas in patients with neurofibromatosis 2, a genetic disorder that puts patients at risk for the tumors. […] Another forthcoming clinical trial uses scorpion venom dye to fluoresce the schwannoma immediately prior to surgery, enabling surgeons to visually distinguish the nerves from the tumor and decreasing the risk of complications. […] We’re pushing new therapies and making the surgeries safer, Yu said. […] We’re working toward developing trials that will provide information for the novel therapies of the future.

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