Acoustic Neuroma Treatment and Surgery (Vestibular Schwannoma)
The first and most important step in treating acoustic neuroma is to establish a cooperative relationship with your treatment team. Our team at UC San Diego Health takes a patient-centered approach and includes experts in surgery, radiology, genetics, radiation therapy, audiology, and rehabilitation.
We provide three surgical treatment options as well as radiation therapy and Gamma Knife radiosurgery. Some patients benefit most from one option or another, but for other patients, multiple options may be appropriate. Sometimes it's a matter of personal choice.
We consider tumor size, age, hearing status, and your personal preferences as we work with you to develop a treatment plan.More About Our Acoustic Neuroma Program
Navigating Your Experience
When you contact the Acoustic Neuroma Program, our team will help you prepare for your first interaction with the doctors. We have two patient navigators who can answer questions, address your concerns, and support you as you prepare for treatment. They are both previous patients and have had surgery for their own acoustic neuromas. They understand the emotional impact the diagnosis and treatment may have and will provide support and assistance as you navigate this process.
When Should an Acoustic Neuroma be Removed?
If your tumor is very large, continues to grow and causes symptoms, surgery may be recommended.
A "wait and watch" strategy can be appropriate if your tumor is small (<2 cm) and you are experiencing few symptoms. This approach generally involves a second MRI in 6 months and then annually as long as there is no growth and symptoms have not changed.
Smaller tumors may show no growth for periods of time, even over several years. But it's important to understand that hearing often declines over time even when the tumor does not appear to be not growing.
Acoustic Neuroma Patient Video: Surgery Helps Restore a Normal Life
Acoustic Neuroma Surgery (Vestibular Schwannoma)
We use and have extensive experience with all three microsurgery approaches: translabyrinthine, retrosigmoid, and middle cranial fossa. The choice of approach is individualized and depends on each patient’s needs.
- The translabyrinthine approach is performed through an incision behind the ear. The surgeon opens the mastoid bone and inner ear structures to identify the tumor within the internal auditory canal and cerebellopontine angle. This is the favored approach for larger tumors in patients with poor hearing or in cases where hearing preservation is unlikely (tumors >2 cm). This approach allows early identification of the facial nerve and has a very low incidence of postoperative headaches.
- The retrosigmoid approach involves an incision slightly farther back behind the ear. This approach can be used for hearing preservation as it does not involve the removal of the inner ear structures. We reserve this approach for patients with useful hearing and tumors that are 2 centimeters or less in diameter and do not extend to the farthest reaches of the internal auditory canal. This approach has a low but finite risk of chronic headaches and is not recommended for patients with a history of troubling headaches.
- The middle cranial fossa approach involves an incision above the ear. The internal auditory canal is approached from above and an experienced surgeon can expose the tumor without compromising the structures of the inner ear. This procedure is reserved for patients with useful hearing and tumors smaller than 1.7 centimeters. This technique offers the highest likelihood of long-term hearing preservation.
A 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.
Radiation Therapy and Gamma Knife Radiosurgery for Acoustic Neuroma
This is a nonsurgical approach often done in an outpatient setting. Radiation can be given as a single dose or in multiple or fractionated doses.
Radiation therapy (more than one session) or Gamma Knife radiosurgery (single session) are useful treatment methods in appropriate circumstances. In general, radiation induces strand breaks in DNA, the genetic material of the cell. This can destroy cells and/or stop growth in some part of the tumor.
Enhanced Therapies for Acoustic Neuroma
Osteopathic Manual Treatment (OMT)
UC San Diego Health offers an inpatient osteopathic manual medicine (OMM) consultation service, available to acoustic neuroma patients after their surgeries. The osteopathic physicians on our team have special training in osteopathic manual treatment (OMT) and provide a whole person, hands-on approach in supporting your healing and recovery.
A pilot study completed at UC San Diego Health noted a reduced average use in daily opiate pain medication by about 42 percent per day. It also showed that patients who received OMT in the days following surgery went home, on average, 0.7 days sooner when compared to patients who did not receive OMT.
Vestibular Therapy
Vestibular therapy is an integral part of your comprehensive care to help you before and after treatment. Our physical therapists have expertise in dealing with issues related to imbalance and dizziness that may be interfering with your daily activities.
Our physical therapists meet with you prior to microsurgery or radiosurgery to gather a baseline status and get you started on exercises that are helpful before and after surgery. They can assess you after your procedure and design an individualized rehabilitation program for you.