There are mainly three modalities of treatment for acoustic neuroma:
1. Observation
Acoustic neuromas are not cancerous, and usually slow-growing. Often doctors monitor a tumour with periodic MRI scans and recommend more aggressive treatment if the tumour grows faster or symptoms become more severe.
2. Surgery
Surgery for acoustic neuromas may involve removing all or part of a tumour. There are three principal surgical approaches for extracting an acoustic neuroma:
a. Translabyrinthine Approach
This method involves making an incision behind the ear and removing the bone behind the ear and some of the middle ear. This procedure is recommended for tumours larger than 3 centimetres. The advantage of this approach is that it allows the surgeon to see the facial nerve clearly before removing the tumour. The disadvantage of this technique is that it results in a permanent hearing loss.
b. Retrosigmoid/Suboccipital Approach
This method involves exposing the back of a tumour by opening the skull near the back of the head. This approach can be used for removing tumours of any size and offers the possibility of preserving hearing.
c. Middle Fossa Approach
This approach involves removing a small piece of bone from the ear canal to access and remove small tumours confined to the internal auditory canal, the narrow passageway from the brain to the inner ear. Middle Fossa approach lets the surgeons preserve the patient’s hearing ability.
3. Total Endoscopic Resection
A newer, less invasive technique called total endoscopic resection allows surgeons to remove acoustic neuromas using a small camera interpolated through a hole in the skull. This method is offered only at selected medical centres by highly trained surgeons. Initial studies claim success rates on par with conventional surgery methods.
4. Radiation Therapy
Radiation therapy is recommended in some patients of acoustic neuromas. Ultra-modern techniques used in this treatment makes it possible to send high doses of radiation to a tumour while limiting exposure and damage to the tissue around the tumour.
There are two widely accepted ways in which radiation therapy is used on the patients. Either one of them is used to treat the patient.
5. Stereotactic Radio Surgery (SRS)
Single-fraction stereotactic radiosurgery, in which multiple small beams of radiation are targeted at a tumour in a single session.
6. Fractionated Stereotactic Radiotherapy (FRS)
Multi-session fractionated stereotactic radiotherapy, which delivers lower doses of radiation every day, for several weeks. Studies imply that multi-session therapy may protect the hearing ability of the patients better than SRS.