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Treatment Options Summary

 

Typical Advantages of Microsurgery over Radiation

  1. Surgery removes the tumor for those that want it "out of their body."
  2. Some patients have a fear of very rare long-term (many years post-treatment) effects of radiation, such as induced malignancy.
  3. Size and/or position of the tumor may make radiation unadvisable, due to post-treatment swelling.  Tumors larger than 2.5 to 3 cm in size are not recommended for radiation.
  4. Younger age is generally another determining factor for choosing surgery.
  5. Subtotal tumor removal may make surgery the best option, followed by radiation.
  6. Some physicians do not recommend radiosurgery for large tumors if there has been prior radiation treatment in the same area.


Microsurgical Options - 3 Approaches - Pros and Cons

Translabyrinthine
Pros:

Oldest approach - longest history.
An option when there is no useful hearing to preserve.
Approach facilitates identification of facial nerve for preservation.
Any size tumor can be removed with this approach.

    Con:
    Results are permanent with complete hearing loss in the AN ear.


      Retrosigmoid/Sub-occipital
      Pros:
      Possible preservation of hearing - 50% chance of this when the tumor is small to medium size.
      Approach provides a good view of the AN in relation to brainstem.
      Possible preservation of facial nerve.
      Any size tumor can be removed with this approach.

        Cons:
        Hearing preservation decreases if the tumor is large.
        Headaches are a more prevalent post-op side effect.


          Middle Fossa
          Pros:
          Possible preservation of hearing with small tumors in the right location, typically confined to the internal auditory canal.

            Con:
            Most often used only with small tumors, typically confined to the internal auditory canal.

                Typical Advantages of Radiation over Microsurgery

                1. Good option for patients in their mid 50's and older or with health issues.
                2. Radiation is typically an outpatient procedure, though some patients may stay in the hospital overnight. The radiation session itself is relatively quick. Some procedures are done in one session and others take several sessions.
                3. There is usually no need to take time off from work. Some people are treated on their way to or from work when having multiple sessions.
                4. There is no recuperation or convalescence time  immediately after treatment.
                5. There are usually no immediate complications. In the medium term there may occasionally be complications, as radiation takes time to fully present symptoms and may cause swelling of the AN.
                6. The tumor can swell for up to 18 months to two years.  Symptoms can be worse during this time and may include acute side effects following radiation treatment.  Some of these may be short term while others may last longer and become long term.

                Disadvantages of Radiation

                1. Long-term success of tumor control is unknown.
                2. Long-term risks of radiation to the surrounding brain are not well known.
                3. Life-long monitoring is required.
                4. Most current data shows that hearing declines over time after radiation.

                Radiation Treatment Options

                Gamma Knife
                Early use for AN began in late 1980's and early 1990's
                Use of head frame attached by pins attached to the patient's skull
                Local anesthetic is used
                Stereotactic radiosurgery
                Always single session


                  Linear Accelerator (LINAC)

                  Generally for ANs used for FSR (multiple sessions)
                  Cyber-Knife is a well-known variation of the LINAC machine which uses a robotic arm guided by X-ray imaging

                    Typical Advantages of "Watch & Wait"
                    Over Microsurgery or Radiation Treatment

                    1. Good option for small tumors, especially in older individuals; AN may not grow and may not require treatment.
                    2. Hearing may be preserved longer in cases where the tumor presents on the only hearing side.
                    3. All medical treatments, surgical or radiation, carry some risks. As ANs are benign and grow very slowly, many physicians will recommend having a second MRI at least 6 months after the first, to establish the growth rate. If the tumor is not growing, avoiding treatment altogether is a possibility.
                    4. In time, safer treatments for acoustic neuromas, other than surgery or radiation, may be found.

                    When to Seek Microsurgical or Radiation Treatment

                    If there is tumor growth
                    If the tumor grows to 2 cm or more, treatment should be considered
                    An increase in symptoms may indicate that the tumor is growing. Symptoms include increased hearing loss, tinnitus, increased balance issues and numbness in the face.

                      Acoustic Neuroma Introduction

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