Acoustic Neuroma (Vestibular Schwannoma) Treatment and Surgery
When it comes to treatment, you have options. Some patients choose to monitor their tumor if it’s small, while others opt for radiation or surgery to address symptoms. Your care team will help you decide what’s best for you.
Surgery may be recommended if your tumor is large, growing, or causing significant symptoms.
Keep in mind that even if your tumor isn’t growing, hearing loss can still happen over time.
Monitoring (Watchful Waiting)
A “wait and watch” approach might be recommended if your tumor is small (less than 2 cm) and causing few or no symptoms. In these cases, your doctor may monitor your condition with regular MRIs every 6 to 12 months to check for changes.
Radiation Therapy and Gamma Knife Radiosurgery
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. It can be delivered as a single session or spread out over multiple sessions.
Gamma Knife radiosurgery, which is very precise and non-invasive, is typically completed in one session.
Surgical Approaches
We have extensive experience with all three surgical approaches to remove acoustic neuromas. The right choice depends on the size of your tumor and your hearing:
Translabyrinthine Approach
- Best for larger tumors (over 2 cm) or when hearing preservation isn’t possible.
- Involves an incision behind the ear and removal of part of the inner ear.
- Benefits: Early identification of the facial nerve and minimal risk of postoperative headaches.
Retrosigmoid Approach
- Ideal for patients with useful hearing and tumors smaller than 2 cm.
- Involves an incision farther behind the ear, which protects inner ear structures.
- Note: There’s a small risk of chronic headaches.
Middle Cranial Fossa (MCF) Approach
- Reserved for small tumors (less than 1.7 cm) and patients with good hearing.
- Involves an incision above the ear and allows for excellent hearing preservation.
High Success Rate of Hearing Preservation
The middle fossa approach requires considerable skill and experience. Our acoustic neuroma surgeons, Drs. Rick Friedman and Marc Schwartz, have worked together for more than two decades to treat acoustic neuromas. They have a high success rate of preserving hearing with middle fossa microsurgery.
Enhanced Therapies for Acoustic Neuroma
Osteopathic Manual Treatment (OMT)
UC San Diego Health offers an inpatient osteopathic manual medicine consultation service to acoustic neuroma patients after surgery. The osteopathic physicians on our team have special training in osteopathic manual treatment and provide a whole-person, hands-on approach to support your healing and recovery. OMT can help reduce the need for opiates and shorten your hospital stay.
Vestibular Therapy
Vestibular therapy involves exercises to reduce dizziness, improve balance and promote faster recovery and return to activity. Our experienced physical therapists meet with you before surgery or radiosurgery to gather a baseline status and get you started on exercises to help you before and after surgery. They can assess you after your procedure and design a personalized rehabilitation program for you.
What to Expect During Your Treatment Journey
Once you have decided to pursue treatment at UC San Diego Health, our surgery coordinator will contact you to schedule your surgery date and pre- and post-surgery appointments.
Pre-Treatment Preparation
After you select your surgery date, we will help you get insurance authorization. We also recommend you contact your insurance provider to confirm that we are in your network and to understand your benefits.
During Acoustic Neuroma Treatment
We ask you to arrive one to two days before your surgery date for pre-operative appointments. The hospital stay is usually two to three nights and you should remain in the local area eight to ten days after surgery for post-operative appointments. These include surgeon consultations, audiograms and a vestibular therapy evaluation.
Immediate Post-Treatment Recovery
Your post-treatment care for acoustic neuroma will include a night in the neuro-intensive care unit, followed by a stay in our step-down unit for high-level care that is less intensive than the ICU. You will be monitored for any potential side effects of surgery, such as facial paralysis and temporary dizziness or balance problems.
Frequently Asked Questions (FAQs)
Get a Phone Evaluation
A phone evaluation with a UC San Diego Health acoustic neuroma doctor includes a complete review of relevant medical records and any related test results, followed by advice on the best course of treatment.
Video: Acoustic Neuroma Surgery Helps Patient Restore Her Life
