Acoustic Tumors – Options

Neurotologist Moises Arriaga of CNC Hearing and Balance Center and Neurosurgeon Frank Culicchia are members of the Acoustic Neuroma Association.  Dr. Arriaga is a past president of the organization.   CNC Hearing and Balance Center is recognized as an Acoustic Neuroma Center of Excellence.

Video transcript:

Acoustic tumors are an important condition that can affect the hearing and balance nerve. These are benign growths of the lining of the hearing and balance nerve and they often start very small but they can grow to be quite large and even be life-threatening. Because they start very small and could present with just a little difference in the hearing, we are very aggressive at identifying them when they are small. So if there’s a difference in hearing between the two ears, we often will get an MRI to identify these growths. These are not cancers. They don’t go to other parts of the body but if they get large enough, they can put pressure on the brain and become life-threatening.

In general, there are 3 treatments for acoustic tumors.

For some patients, particularly if the tumor is small we will simply get another scan in 6 months and if it’s not growing, we will go ahead and scan on a yearly basis to make sure the tumor does not pose a threat.

Another treatment strategy is to remove the tumor and there are two ways to do that. In one strategy, we go right through the inner ear itself to reach the tumor. We cannot save the hearing but it means we don’t have to put any pressure around the brain to take the tumor.

The other strategy is one that gives us about a 70% chance of saving hearing and 50% chance of keeping the hearing at the current level. Those are hearing preservation tumor surgeries. We can do that from above with the middle fossa operation and from behind with the retrosigmoid operation.

The third general treatment for acoustic tumors is radiation. We like to use stereotactic radiation, which means the radiation is focused on where the tumor comes from. This is not like the old days where people get their whole head radiated and lose all their hair and have all sorts of brain issues related to that. Instead, this is highly focused radiation on the tumor. 90% of the time this radiation is effective at preventing the tumor from growing. However, whenever we use radiation we always mention the tiny possible risk of turning this from noncancerous to cancerous. Also, radiation is not very effective at preserving the hearing on a long-term basis. However, if the risks of surgery are substantial because of other medical problems radiation is a wonderful way to control these tumors before they get a chance to cause significant compression of the brain.