What Are The Symptoms Of A Schwannoma
Cranial schwannomas include vestibular schwannomas, trigeminal schwannomas and facial schwannomas.
Vestibular schwannomas can cause hearing loss, facial numbness, pain or weakness, headaches, imbalance, swallowing difficulties and weakness.
Trigeminal schwannomas can cause facial numbness, imbalance, weakness, headaches, and hearing loss.
Facial nerve schwannomas can cause facial weakness, hearing loss or imbalance.
Stereotactic Radiosurgery For Acoustic Neuroma
Radiosurgery, also called stereotactic radiosurgery, is a noninvasive procedure that uses precisely focused, narrow beams of radiation to treat the acoustic neuroma while limiting the amount of radiation that affects surrounding structures, including the hearing, balance and facial nerves. This form of radiation therapy can reduce the growth of an acoustic neuroma. Doctors may recommend radiosurgery for older patients with acoustic neuromas who might be too fragile to endure more invasive treatment. Radiosurgery may also be used in combination with surgery for large tumors that cannot be removed completely without permanently damaging the facial nerve or other structures.
Some studies report cancers developing within the field of radiation treatment for acoustic neuroma.
What if an acoustic neuroma returns after radiosurgery?
Radiation treatment requires ongoing follow-up and annual scans to watch for tumor regrowth. Parts of the tumor unaffected by the radiation may give rise to new growth. Signs of an acoustic neuroma coming back could include facial muscle weakness and spasms that slowly worsen, and new growth can often be seen on an MRI scan. Few studies have documented the effects of radiation beyond five years.
The Johns Hopkins Acoustic Neuroma Center
What Can I Expect After Surgery For An Acoustic Neuroma
After surgery, you will likely stay two to three nights in the hospital. In most cases, you will not need to be in an intensive care unit . After surgery, you may feel some head discomfort and fatigue. Most patients will go home after the hospital and we recommend everyone undergo outpatient physical therapy focused on balance exercises.
You will need follow-up care, including:
- Tests to check your hearing, balance and facial nerve function.
- Rehabilitation, in some cases, to improve balance.
- MRI scans to confirm the tumor has been completely removed.
- Imaging scans after surgery to monitor the area.
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How Is A Vestibular Schwannoma Diagnosed
Unilateral/asymmetric hearing loss and/or tinnitus and loss of balance/dizziness are early signs of a vestibular schwannoma. Unfortunately, early detection of the tumor is sometimes difficult because the symptoms may be subtle and may not appear in the beginning stages of growth. Also, hearing loss, dizziness, and tinnitus are common symptoms of many middle and inner ear problems . Once the symptoms appear, a thorough ear examination and hearing and balance testing are essential for proper diagnosis. Magnetic resonance imaging scans are critical in the early detection of a vestibular schwannoma and are helpful in determining the location and size of a tumor and in planning its microsurgical removal.
Auditory Brain Stem Response Test
An auditory brain stem response test provides doctors with information about how well the sound signal is traveling from the inner ear, along the eighth cranial nerve, to the brain stem and to its upper auditory areas. Delay in this signal transmission may prompt doctors to conduct further tests.
During an auditory brain stem response test, a doctor attaches small metal discs called electrodes to your head. The electrodes measure brain wave activity in response to sound that is delivered through a set of headphones or ear inserts. Unusual test results are a sign of acoustic neuroma.
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Possible Symptoms Of Acoustic Neuroma On Brainstem
Headache
Impaired control of voluntary body movements
Confusion
Visual problems
But an acoustic neuroma thats in contact with the brainstem in the early stages of this contact will not always cause symptoms.
Blausen.com staff /CC BY 3.0/creativecommons.org/licenses/Wikimedia Commons
Tumors of any size can be discovered incidentally including very large tumors with significant brainstem compression, says Brandon Isaacson, MD, F.A.C.S., Department of Otolaryngology Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX.
Dr. Isaacson is one of the few surgeons in the U.S. who removes small acoustic neuromas via endoscopy: insertion of a thin tube through the inner ear, guided by a camera that displays the internal image on a screen.
The only incision required is a small one in the ear canal.
Dr. Isaacson continues, These tumors are in most cases slow growing, and early symptoms are often not addressed by the patient and the clinician.
If a tumor grows very slowly the brain tends to tolerate this well, but a faster growing tumor will typically present earlier.
Rarely there can be bleeding within the tumor that can cause rapid expansion and severe symptoms.
An acoustic neuroma is benign , but left untreated, it can cause local and serious harm that involves the brainstem.
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Initial Early Symptoms Of An Acoustic Neuroma
A slow growing brain tumour, such as an acoustic neuroma, develops over years, and often over decades, and correspondingly often causes only a few complaints during this long time period.
Given that an acoustic neuroma grows on the nerve sheath of the nervus vestibulocochlearis , the first disorders affect an acoustic neuroma sufferer’s balance and hearing.
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Can The Surgeon Preserve My Hearing
Your surgeon monitors your hearing during surgery to increase the chances of hearing preservation.
People with large tumors that have seriously affected hearing have a lower chance of preserved hearing. About 50% of people who have small to medium tumors and good hearing before surgery will hear in that ear after surgery.
What Treatments Are Available
The treatment that is right for you will depend on your age, general health, hearing status, and the tumor size. The larger the tumor, the more complex the treatment. Therefore, early recognition, diagnosis, and treatment are essential. Because patients and acoustic neuromas differ, it is important to seek treatment at a medical center that offers the full range of options, including surgery, radiosurgery, and hearing or facial rehabilitation. A neurosurgeon, otologic surgeon, and radiation oncologist work as a team to treat acoustic neuromas.
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How Will We Find A Cure For Acoustic Neuroma
Research we are funding across all of our Centres of Excellence will help lead towards finding a cure for a wide range of brain tumours.
Our University of Plymouth Centre of Excellence is Europes leading research institution for low-grade brain tumours, and has a strong focus on schwannoma, acoustic neuroma and neurofibromatosis 2.
They have developed an all-human cell model of schwannoma, developed from tissue samples donated by patients who have undergone surgery. This model is being used in laboratory experiments designed to learn more about the causes and behaviour of schwannomas, and ultimately to find a cure by developing targeted drug therapies.
Scientists at our Brain Tumour Research Centre of Excellence in the University of Portsmouth have also collaborated with the University of Plymouth Centre of Excellence on some aspects of schwannoma research.
Their findings can be used to develop treatments that target particular molecular pathways and hence influence the processes that they control. They have also developed models of the blood brain barrier that support research into drug therapies for all types and grades of brain tumours.
Besides Asymmetric Hearing Loss What Are Other Symptoms Of Acoustic Neuroma
Dr. Zwagerman: Symptoms can include one-sided tinnitus, balance issues, dizziness, facial numbness, tingling or weakness even swallowing problems.
Dr. Harris: If someone has hearing loss in one ear and not the other, its a red flag that deserves investigation. Rarely, vertigo, or a room spinning sensation, may also be a symptom. When the tumor is large enough to compress the brain stem, headaches and other symptoms can arise.
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What Are Acoustic Neuroma Treatment Options
Acoustic neuroma treatment depends on the size and growth speed of the acoustic neuroma, severity of the patient’s symptoms and overall age and health of the patient. Doctors may choose to monitor the acoustic neuroma if the patient isn’t a good candidate for surgery because of other conditions. Surgeries and radiation therapy are key treatment options.
How Does An Acoustic Neuroma Affect People
The tumor can cause symptoms most commonly by affecting hearing or balance functions. More than 90% of acoustic neuromas affect the hearing nerve in one ear, which is called unilateral hearing loss.
An acoustic neuroma can also press on nerves that control your facial movement, sensation and expression. Large tumors that press on brain structures that control the flow of spinal fluid out of the brain can be life-threatening.
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What Is Recovery From Acoustic Neuroma Surgery Like
Recovery from acoustic neuroma surgery depends on the patients overall health before and after surgery. Routine hospitalization usually ranges from three to five days after surgery. Immediately following surgery, acoustic neuroma surgery recovery begins with a one- to two-day stay in the Intensive Care Unit followed by two to three days on a hospital floor with specialized neuro-trained nurses and physician assistants.
An important part of acoustic neuroma surgery is preserving the functionality of the facial nerve, which controls facial movement and the closing of the eyelid. Closing the eyelid is an important function that protects the eyespecifically the cornea. If the cornea is not protected, it can lead to a cornea ulcer and potential blindness.
After surgery, if the facial nerve is not working and the eyelid cannot close completely, a plastic surgeon may perform a temporary procedure that inserts a gold or platinum weight into the upper eyelid, giving the eyelid enough mass to fully close. Neuro-ophthalmologistseye doctors that specialize in neurological disordersare also a part of the multidisciplinary team approach here at the Neurosciences Center and will be part of your care after surgery to ensure the eye is cared for properly.
What Complications Are Associated With Acoustic Neuroma Surgery
Like all cranial surgeries, there is a risk of bleeding, infection, injury to the brain and risk of injury to one of the blood vessels in the brain that may result in a stroke, coma or even death, which is why having a well-trained and experienced care team is vital. The goal of the surgical procedure is about removing the acoustic neuroma while simultaneously preserving the facial nerve and hearing.
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How Are Acoustic Neuromas Treated
Watch and wait
Some acoustic neuromas may not need immediate treatment, this is usually when they are small and not causing symptoms. If this is the case, youll usually be put on active monitoring and youll see your specialist for regular check ups or MRI scans every 3, 6 or 12 months.
Surgery for acoustic neuroma
Neurosurgery is usually only used to remove larger acoustic neuroma brain tumours as it can result in the loss of hearing in the affected ear. Your surgeon will explain what is involved in the procedure and potential risks and complications. The surgeon may leave a small part of the tumour to prevent damage to the facial nerve. Any tumour cells that are left behind can be treated with stereotactic radiosurgery.
You may wish to discuss the possibility of having a bone anchored hearing aid with your surgeon. This diverts sound from your affected ear to your good ear. Occasionally surgery can result in damage to the facial nerve, causing your face to droop on one side or difficulty in closing that eye.
Acoustic neuromas very rarely return after surgery, but you may continue to have regular MRI scans.
Even with treatment, symptoms such as tinnitus and hearing loss can persist. These symptoms will require additional treatment.
How Common Is It
Acoustic neuromas are rare. Between 1 and 20 people in every million worldwide are diagnosed each year with an acoustic neuroma. Acoustic neuromas account for about 8 in 100 brain tumours. They are more common in middle-aged adults and are rare in children. Acoustic neuromas seem to be more common in women than in men.
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How Is Acoustic Neuroma Detected
Acoustic neuroma can be hard to detect in its initial stages because its symptoms are often relatively minor and may go unnoticed. Early signs also may be similar to those of other disorders, leading to misdiagnosis. However, early detection and prompt treatment can help reduce the risk of more severe complications in the future.
Early signs of acoustic neuroma include:
- Gradual hearing loss in only one ear
- Ringing in only one ear
- Feeling of fullness in only one ear
How Is An Acoustic Neuroma Diagnosed
Your healthcare provider will ask you about your symptoms and perform a physical exam. You will also have a series of hearing and balance tests and scans, which may include:
- Audiogram to check hearing ability.
- Electronystagmography, which tests balance and records eye movement to check how your eye and ear nerves are functioning.
- Auditory brainstem response to measures how hearing nerves response to sound and check brainstem function.
- MRI and CT scans to locate the tumor and measure its size.
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What Is An Acoustic Neuroma
An acoustic neuroma, also called vestibular schwannoma, is a benign, slow-growing tumor that arises from the Schwann cells forming the sheath of the vestibulocochlear nerve. As the tumor grows, it expands from its origin inside the internal auditory canal out into the space between the brainstem and the bone known as the cerebellopontine angle. The pear-shaped tumor can continue to enlarge, compressing the trigeminal nerve, which is responsible for facial sensation. Eventually, the tumor can compress the brainstem. Acoustic neuromas are classified according to their size as small , medium , or large .
Figure 2.
What Is The Next Step If I Am Diagnosed With An Acoustic Neuroma
If you are diagnosed with an acoustic neuroma, the amount of information you receive can seem overwhelming. It is important to know that decisions for treatment rarely need to be made immediately. After diagnosis, your next step may involve referral to a specialist.
You should expect a team of specialist doctors to be involved in your care, including ENTs with specialty training , neurosurgeons, and/or a radiation oncologist and a physical therapist.
The team of physicians and clinicians involved in the care of acoustic neuromas will often work together to coordinate a plan that optimizes your needs.
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Other Signs Of Acoustic Neuroma
Acoustic neuromas can also put pressure on other important cranial nerves that are adjacent to where these tumors grow.
These symptoms can be caused by many other, more common health issues such as cholesteatoma, labyrinthitis and vestibular neuritis, and Menieres disease. If you have more than a few of these symptoms , your doctor can help you decide whether more testing is necessary.
When Is Surgery Recommended And What Are The Approaches
Dr. Harris: This is where we consider the patients age and their tumors likely growth rate. As the disease is benign, the patient has the option, in many cases, of observation, surgery or radiation therapy. When tumor growth is demonstrated, radiation therapy or surgery is warranted. If a tumor is large, surgery may be the best option. The general trend is for younger patients to skew more toward surgery. For this group, tumor regrowth and other considerations with radiation therapy may be more significant. Older patients skew more toward radiation therapy. However, this is not a hard-and-fast rule, and the treatment plan is tailored for each individual.
Dr. Zwagerman: For example, a young person who has a tumor that is growing may have 60 years ahead of them, but if the tumor causes brain issues like hydrocephalus, it can be fatal. If the tumor is not treated, theres also the risk of other problems like facial pain, worsening hearing loss and balance problems.
Dr. Zwagerman: Each approach has risks and benefits. If the patient presents with normal or functional hearing, for example, our goal is to save it. This is dictated by how big the tumor is. If the primary issue is balance, we use the approach that best addresses that symptom.
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How Does Acoustic Neuroma Progress
A fast-growing acoustic neuroma may eventually put pressure on other nerves or the brain stem. These cases are rare, but they can result in symptoms that are generally more widespread and/or severe than those typical of a smaller neuroma.
Potential complications include:
- Weakness or paralysis of facial muscles
- Chronic numbness or tingling in facial muscles
- Difficulties with swallowing
- Persistent headaches
- Accumulation of fluid in the brain, which may cause uncontrollable muscle movements, confusion, and headaches. In very rare cases, these complications can be life-threatening.
How Common Are Acoustic Neuromas
Dr. Harris: Historically, acoustic neuromas have been estimated to affect about one in 100,000 people. Newer studies suggest these tumors may affect one in 500. The upward trend may be due to greater awareness of the condition, more frequent hearing screenings or more frequently performed MRIs that result in an incidental finding of acoustic neuroma.
Dr. Zwagerman: We see patients with acoustic neuromas every week in our clinic. We have one of the busiest practices in Wisconsin for this condition. Our team-based approach considers patients needs and life situations to ensure they receive excellent care.
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What Are The Possible Complications
The possible complications due to the acoustic neuroma include:
- The most common symptom of an acoustic neuroma is hearing loss.
- The extent to which you will be affected by hearing loss varies from person to person.
- ‘Water on the brain’ :
- If your acoustic neuroma grows very large, a complication called hydrocephalus can occur. This happens because the flow of fluid in the brain is obstructed.
- Pressure can build up inside the brain, leading to permanent brain damage if not identified and treated.
- The condition can be treated by inserting a drainage tube to relieve the pressure and allow the cerebrospinal fluid to flow.
- Hydrocephalus is very unlikely if you have treatment for an acoustic neuroma.
- Damage caused by pressure on other nerves in the brain, or on the brainstem:
- If the acoustic neuroma is growing and untreated, it can cause problems by pressing on nearby structures in the brain. Long-term pressure can cause permanent damage.
- For example, it is possible that the trigeminal nerve or the facial nerve can be affected.
- If you have treatment for your acoustic neuroma before it has had the chance to grow very big , this sort of complication is very unlikely.
