IG Akustikusneurinom (IGAN)

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Operation / Videos

Operation

Treatment

As neuromas generally develop very slowly, a period of observation and watching ("watch and wait") is often justified. Possible tumour development, though, should be checked every six months, using MRI scans. The tumour must be removed if there is continued growth and/or a compromised brain structure.

If there is growth in the inner auditory canal (intrameatal), surgery is done are carried out by ear-nose-throat (ENT) surgeons, whereas those outside the auditory canal and in the cerebello-pontine angle are taken care of by neurosurgeons (extrameatal).

Radiotherapy

Small and medium-sized tumours can also be treated with radiotherapy. This is done as a one-off radiation exposure using gamma knife equipment, with stereotactic radiation surgery using a liner accelerator, or more conventionally in multiple sessions spread over a period of weeks. The use of radiotherapy is an alternative to an operation, particularly for older people. It should also be noted that there are still no long-term studies of such treatment. If the radiotherapy results in the development of a new tumour then this must be surgically removed.

Operation

If the afflicted person opts for a surgical approach, due to the size of the tumour and/or continued growth, IG Akustikusneurinom only recommends calling hospitals that can provide the necessary acoustic neuroma specialists. Today, these hospitals have proven themselves to be extremely successful. The goal of every operation is and must be the complete removal of a tumour without damage to any of the cranial nerves. This goal is unfortunately in many cases not always achieved. In about 38% of the cases - other studies suggest even more - patients become deaf after the intervention. Temporary or permanent facial paralysis is also not uncommon. There are also some studies made during recent years that indicate that the quality of life is in many cases worse after the operation than before it..The decisive thing is to know that the surgical techniques for one and two centimetre tumours are much the same (watchful waiting strategy without compromising the brain stem).

Even small tumours can lead to deafness. A decisive factor is the consistency of the tissue. Hard and small tumours are difficult to remove from the nerves. Patients must therefore discuss with the surgeon prior to the operation whether residual tumour can be left, with the associated risk of a relapse (15-18%), or severing the nerve, with the associated social consequences. Many patients find such decisions very difficult.

These studies/results and potential post-operative consequences are still not acceptable for IG Akustikusneurinom and make us keen to provide advice regarding the correct choice of treatment, and to actively collaborate with in research initiatives.

We have addresses and contacts for the hospitals with the best surgical results in Europe, and we are happy to help you to establish contact with these institutions, to accompany affected patients, or to provide advice when it comes to selecting the desired choice of treatment. Of great importance is the completely impartial and NEUTRAL ANALYSIS in comparing international acoustic neuroma studies.

"Wait and see" treatment

Not every acoustic neuroma must be immediately treated. They should of course be monitored, but today specialists are not wedded to the idea that every tumour must be operated on as soon as it is discovered. A period of waiting accompanied by regular MRI checks is also a perfectly justifiable alternative. This course of action is however, as is often the case, only usually proposed for a certain group of patients. These are primarily younger patients and/or those with small tumours or with tumours not causing functional impediments. However, such cases should include regular check ups and knowledge about possible indicators of tumour growth (e.g. increasing hearing impairment, dizziness, ringing in the ears, recurring headaches). (Source: Erlangen University Hospital)

AKN Film

The following film shows the individual stages involved in removing an AN (acoustic neuroma). The operation was a collaboration between the ENT and neurosurgical units. The patient is sitting during the operation.

The acoustic neuromais on the patient's right hand side. The tumour can be seen in the centre of the picture. On the left the cerebellum is held out of the way using a brain spatula. The pars petrosa
is on the right hand side, covered by meninges (dura). First the nerve structure is stimulated in order to detect where the facial nerve is. Then the tumour is gradually removed by the neurosurgeon. The ENT unit then opens the inner auditory canal with a diamond milling cutter, and then follows the removal of the tumour parts remaining in the inner auditory canal.

The tumour was fully removed. Both the acoustic and facial nerves remained functional i.e. the ability to hear and the facial nerve functions were still present after the operation. (Source: Fulda Hospital)

AKN-Film

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IG Akustikusneurinom (IGAN)

Postbox | CH-6330 Cham | Tel. +41 41 785 51 82 | Fax +41 41 785 56 09
www.akustikusneurinom.ch | info@akustikusneurinom.ch