Surgical removal of an acoustic neuroma is a complex and delicate process. In general, the smaller the tumor at the time of surgery, the fewer the complications. The hospital stay after microsurgery is getting shorter, generally three to five days on average, with approximately four to six to twelve weeks suggested for recovery. Longer stays may be necessary for patients with large tumors. Patients routinely spend at least one night after surgery in the intensive care unit for close monitoring. The time after surgery can be filled with days or perhaps weeks of new sensations. There is usually head discomfort and fatigue. Some patients may experience emotional lows after major surgery, and those lows are believed to be a part of the natural healing process. Some patients require a period of either outpatient or inpatient rehabilitation for balance issues. Other potential postoperative complications (which are discussed preoperatively between patient and surgeon) may prolong hospitalization.
Even when tumor removal has been accomplished, there is a small chance of tumor recurrence. Therefore, a follow-up MRI after tumor removal should be performed within one to five years.
There are few acute side effects following SRS or FSR. Hearing loss, if it is going to occur, usually happens several weeks or months after treatment and can continue to progress. In radiosurgery patients, tumor cell growth is not arrested immediately. Some tumor cells die in a matter of weeks, but others do so more gradually, generally 6 to 18 months after treatment. While this treatment usually arrests the growth of the tumor and some tumors will shrink in size, the tumor does not disappear. Follow-up scans are important because some tumors will continue to grow after this treatment or at some time in the future. It is not possible to determine which tumors will continue to grow larger after radiation. Therefore, periodic MRI's are necessary throughout life.
It is important to stay active after treatment as this is the best way to combat the dizziness. Often the expertise of a qualified physical therapist can hasten recovery.
Residual Problems After Treatment
A minority of patients experience short and long-term issues after treatment. These include hearing loss, dizziness, facial weakness and headaches. Care and solutions for these issues should be organized by your treatment team. Cerebrospinal fluid leak (CSF), clear fluid from the nose or headache with a fever need to be addressed immediately. Besides hearing loss, the most common problems are excessive eye dryness, balance difficulties, tinnitus, facial weakness and headaches. Separate booklets are available from ANA on these topics. (Click here to go to the ANA store to purchase booklets, or if you are a member of ANA, you can see all our booklets in our member section by clicking here and entering your username and password.) Postoperatively, a small percentage of patients experience cerebrospinal fluid leak (CSF) through the incision or nose, and this occurrence should be reported to the surgeon promptly.
Patients with large tumors are likely to have significant hearing loss and are in a situation where preservation of hearing is unrealistic or impossible. In most cases, the best chance to preseve hearing with either surgery or radiation is when the tumor is small.
Patients with partially preserved hearing may benefit from a hearing aid. If there is total single-sided hearing loss, the patient might want to try one of the many hearing devices available. Some use a CROS (Contralateral Routing Of Sound) hearing aid system, whereby a microphone type of hearing aid on the non-hearing ear routes the sound to the normal hearing ear, providing some hearing from the deaf side. The sound may also be conducted from the tumor side to hearing side via the bone with an implanted hearing device. These devices have gained popularity in habilitating single sided deafness related to acoustic neuromas because of the excellent sound quality and the need for only one device which is worn behind, not in, the ear.
Tinnitus or "ear noise" is common in acoustic neuroma patients, and preservation of hearing may not eliminate the tinnitus. Similarly, removal of the hearing nerve with the tumor generally does not eliminate the tinnitus.
Within up to two years following treatment, the tumor can swell due to inflammation from the radiation and increase sypmtoms. Typically this is short-term and improves within time. Patients can develop facial numbness, facial weakness or deafness on the side of treatment. These deficits typically occur between 6-18 months after treatment.
Note: In a continuing effort to advance the understanding of acoustic neuromas, ANA occasionally conducts patient surveys. The 2007-2008 patient survey results are available online on our website at www.ANAUSA.org. The results provide information regarding symptoms, diagnosis, treatment and post-treatment issues experienced by acoustic neuroma patients.