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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 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 care and observation. 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.
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.
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. This treatment usually arrests the growth of the tumor and some tumors will shrink in size, but 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.
Residual Problems After Treatment
Some, but not all, patients experience short and long term problems after surgery and the patient should be aware of the complications that exist. 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. Some 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 percentage of patients in whom hearing can be preserved increases with decreased tumor size. 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 via the bone with a bone-anchored hearing aid such as the BahaŽ. A newer option is Trans EarŽ which is a bone-conduction behind-the-ear hearing aid.
Tinnitus or "ear noise" is common in acoustic neuroma patients, and preservation of hearing does not eliminate the tinnitus. Removal of the hearing nerve with the tumor, however, does not increase the likelihood that the tinnitus will also disappear.
Radiosurgery, because it is an outpatient treatment performed under local anesthesia, is not associated with most of the complications of open surgery - such as infection, CSF leak, stroke, or systemic problems. Occasionally, patients develop facial numbness, facial weakness or deafness on the side of treatment. This typically occurs between 6-18 months after treatment, and is usually temporary, except for the hearing loss.
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