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Acoustic Neuroma

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About the Disease

Acoustic neuroma, also known as vestibular schwannoma or neurilemmoma, is a non-cancerous tumour of the vestibulocochlear nerve. This nerve connects the inner ear to the brain and has two sections: one transmits sound, while the other helps send balance information from the inner ear to the brain.
Acoustic neuromas typically grow slowly. Although they do not damage the brain directly, they can exert pressure on it as they grow. Larger tumours can press on nearby cranial nerves that control facial muscles and sensation. If tumours become large enough to press on the brainstem or cerebellum, they can be life-threatening.

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Symptoms

Early symptoms of acoustic neuroma are often subtle and may be mistaken for age-related changes, leading to delayed diagnosis. Initial signs include a gradual loss of hearing in one ear accompanied by tinnitus (ringing/buzzing in the ear). Rarely, acoustic neuromas cause sudden and unexplained hearing loss. Other symptoms may include:

  • Facial numbness or intermittent tingling sensation
  • Vertigo (usually unsteadiness rather than spinning)
  • Balance disorders
  • Facial weakness
  • Change in taste
  • Trouble swallowing
  • Hoarseness of voice
  • Cognitive disturbances

Persistent symptoms should prompt clinical consultation.

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Diagnosis

  • Vestibular Evaluation: Videonystagmography (VNG) is a crucial diagnostic tool.
  • Audiometry: Used to assess hearing acuity in both ears.
  • Imaging: MRI of the brain with contrast confirms the presence of an acoustic neuroma
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Treatment

There are three primary treatment modalities for acoustic neuroma:
  • Observation Acoustic neuromas are non-cancerous and typically slow-growing. Doctors may monitor the tumour with periodic MRI scans and recommend more aggressive treatment if it grows faster or symptoms worsen.
  • Surgery Surgery may involve removing all or part of the tumour. There are three principal surgical approaches:
a. Translabyrinthine Approach:
  • Involves an incision behind the ear and removal of bone behind the ear and some of the middle ear.
  • Recommended for tumours larger than 3 centimetres.
  • Advantage: Allows the surgeon to see the facial nerve clearly before removing the tumour.
  • Disadvantage: Results in permanent hearing loss.
b. Retrosigmoid/Suboccipital Approach:
  • Involves opening the skull near the back of the head to expose the tumour.
  • Can be used for tumours of any size and offers the possibility of preserving hearing.
c. Middle Fossa Approach:
  • Involves removing a small piece of bone from the ear canal to access and remove small tumours confined to the internal auditory canal.
  • Allows for the preservation of hearing ability.
  • Total Endoscopic Resection
    • A newer, less invasive technique using a small camera inserted through a hole in the skull.
    • Offered only at select medical centres by highly trained surgeons.
    • Initial studies show success rates comparable to conventional surgery.
  • Radiation Therapy
    • Recommended for some patients with acoustic neuromas.
    • Modern techniques deliver high doses of radiation to the tumour while limiting exposure to surrounding tissue.
    Two widely accepted methods:

    a. Stereotactic Radiosurgery (SRS):
    • Delivers multiple small beams of radiation to the tumour in a single session.
    b. Fractionated Stereotactic Radiotherapy (FSR):
    • Delivers lower doses of radiation over several weeks.
    • Studies suggest this method may better preserve hearing compared to SRS.
These treatment options aim to manage symptoms, control tumour growth, and improve the patient’s quality of life.

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