Acoustic neuroma also known as vestibular schwannoma is a slow-growing tumor which generally does not require any treatment but sometimes it may be following a fast-growing pattern, and then the treatment is essential. Surgical intervention is a common mode of treatment for the removal of acoustic neuroma and is also a highly successful form of treatment.
Is Acoustic Neuroma Surgery Dangerous?
In earlier times, the surgery was more dangerous because of less technological advancements and the mortality rate was high, even recorded up to 40%. Nowadays significant up-gradation in technology has supported the treatment very well and reduced the mortality rate to less than 1%. The complications occurring after the treatment like hearing loss, tinnitus and damage to the facial cranial nerve, etc. have reduced too much lower incidence. The anesthesia and its techniques have improved a lot since earlier times have which increases the likelihood of success of the surgery.
The different approaches have been devised by various surgeons to reach the area of the internal acoustic meatus and cerebellopontine angle. Each of the approaches has its advantages and disadvantages over one another. Commonly three surgical approaches have been described, the translabyrinthine approach, the middle cranial fossa approach, and the rectosigmoid approach.(1)
The surgical intervention for acoustic neuroma is itself a dangerous treatment. Opening up of the skull and removing a part of it could never be counted as a safe surgery whether any approach is used to open it. The brain surgery itself poses many high risks to the life of patient irrespective of the cause. Also the safety depends upon the individual requirement like a patient preferring hearing loss as a side effect but wants the complete resection of the tumor will usually like the translabyrinthine approach whereas a patient preferring hearing ability and can sacrifice to live with the tumor will more likely to go with the middle cranial fossa approach due to its high chances of saving the hearing ability. But to choose between the three approaches for the risk factors, then the have approach is the best one. It is safest among the three surgeries but has significant post-operative effects like complete hearing loss, tinnitus, etc.
How Long Is The Surgery?
The surgery for removing acoustic neuroma via any approach usually takes 4 to 5 hours approximately to complete. Experienced surgeons and larger teams with high technological advances can complete the surgery in even three hours. Sometimes removal of the larger tumors and from the internal acoustic meatus can take 6 to 7 hours for the completion. Bilateral acoustic neuroma usually associated with neurofibromatosis can take even a longer period of time for surgery if operated upon simultaneously on both sides and only a single team is working. It also increases the risk of surgery to many folds due to a longer period of anesthesia as well as more bleeding and surgery-related complications.
The other treatment modality available now is stereotactic radiotherapy. It works by pointing the radiotherapy at a particular spot on the tumor to deliver a fixed amount of radiation calculated, required for treatment of the tumor. It is a non-invasive technique and has high precision with the lesser surrounding damage and side effects.(1)
Although the acoustic neuroma tumors do not require treatment in most of the cases and further cases can be managed by medical treatment only. Some rapid growing tumors can require surgical treatment. It is not a wise choice to say that it is a safe surgery because itself poses various unwanted side effects but the complications have reduced too much extent. The mortality rate has also decreased to less than 1% as compared to earlier times when it was as high as 40%.
The time taken for the surgery is high and is counted as a long period of surgery. It also depends upon the expertise of the surgeon as well as the technology available at the hospital.