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Post Treatment
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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 complications. The hospital stay after microsurgery is getting shorter, generally three to five days on
the 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 of neurological status. 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 imbalance. 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. 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 6-18 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 studies are
important because some tumors will continue to grow after this treatment or at some time in the future. It appears that the
tumor growth will be controlled in a high percentage of cases. 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 either surgery or radiation for an acoustic neuroma to help retain the balance system
and reduce feelings of imbalance or dizziness.
Residual Problems After Treatment
A minority of patients experience short and long term problems after surgery and even after radiation therapy. 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. (See an order form at the back of this booklet.)
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 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 using the BAHA implant (bone-anchored hearing aid). This device has 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 does not eliminate the tinnitus.
Similarly, removal of the hearing nerve with the tumor generally does not eliminate the tinnitus.
Radiosurgery, because it is an outpatient treatment performed without sedation or under local anesthesia, is not associated
with most of the complications of open surgery—such as infection, CSF leak and other postoperative problems. Occasionally,
patients develop facial numbness, facial weakness or deafness on the side of treatment. These deficits typically occur
between 6-18 months after treatment and, other than hearing loss, are usually temporary.
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