What Is The Best Treatment for Acoustic Neuroma?

Acoustic neuroma is a slow-growing tumor of the vestibular part of 8th cranial nerve which rarely becomes symptomatic and even more rarely requires treatment. Treatment for the acoustic neuroma depends upon the staging, extent of spread of the tumor, etc.

What Is The Best Treatment for Acoustic Neuroma?

Due to its slow-growing and non-malignant properties, these tumors do not require any form of treatment for them. The growth sometimes becomes so slow that people often survive a lifetime without even experiencing any symptoms and tumor is detected after death during the autopsy. Sometimes patients undergo brain investigations for other purposes and an acoustic neuroma is detected incidentally with patients experiencing absolutely no symptoms related to the tumor. In those cases, the first-line treatment is to wait and watch. Continuous follow up is required to monitor the growth rate and spread of the first-line. Patients are called upon regular intervals of six months or one year on an outpatient basis to check the growth of tumor and appearance of any related symptoms in the time period.

If the tumor becomes sufficiently large enough that it requires treatment then surgical intervention is a common mode of treatment for the removal of acoustic neuroma and is also a highly successful form of treatment. Various different approaches are used to reach the site of the tumor because of a difficult location. The approaches commonly used are the translabyrinthine approach, the rectosigmoid approach, and the middle cranial fossa approach.[1]

What Is The Best Treatment for Acoustic Neuroma?

The most commonly used approach is the translabyrinthine approach because it has the feasibility to resect, the whole of the tumor. Although, it is associated with loss of hearing ability maximum cases and is a side effect of this approach. The middle cranial fossa approach for the treatment of acoustic neuroma is the best approach to save the hearing ability of the patient because It implies minimal dissection of the surrounding tissues. But this approach usually compromises the resection of the tumor if followed for large size tumors and some of the tumor tissue could be left behind. There is to wait dissection done in the rectosigmoid approach which ensures complete removal of the tumor but has the poorest prognosis in terms of side effects of the surgery.

Nowadays, a newer treatment based on radiotherapy is introduced known as stereotactic radiotherapy.[2] In this treatment, the tumor is precisely located with the help of brain imaging techniques and the dosage of radiotherapy is calculated based upon the size and other features of the tumor. Then the tumor location is marked with the help of a laser and the calculated dosage is given to the tumor. Usually, it regresses and gets cured in only one round of it but multiple rounds can give if required. It has not become a first-line treatment because it is very costly and is not affordable to everyone.

A hearing aid can pre-provided to patients with hearing loss in small tumors or postoperative side effect. Medical treatment can also be given in in patients presenting with other symptoms like nausea, vomiting, dizziness, etc.

Conclusion

Waiting approach is usually applied in non-symptomatic patients of acoustic neuroma. Initial treatment would be supportive with the target towards symptomatic relief to the patients. Hearing ability can a by the use of hearing aids in the management of early symptoms or after the operation.

Surgical resection can be done if the size has exceeded the other treatment modalities and if the patient opts for this choice. The various approaches used for the treatment of acoustic neuroma are also dependent upon the available technology at the hospital and on the expertise of the surgeon. The hearing ability could be saved in small size tumors and but the resection of the tumor is much more important than saving the hearing ability.

Safety from radiation exposure and reporting of known genetic disorders in parents of the children at the earliest are the best preventive measures for acoustic neuroma.

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