Acoustic neuromas can often be removed completely with surgery. However, many acoustic neuromas are so small that they may not need immediate treatment.
The treatment for acoustic neuromas depends on many factors, including:
- The size of the tumor
- The patient’s age
- The patient’s general health and preferences
A multi-disciplinary team of doctors work together to recommend the most effective and safest treatment options for each patient.
Surgical treatment options for acoustic neuromas:
Treatments include surgery, radiosurgery and sometimes observation. Neurosurgeons and neuro-otologists at Johns Hopkins perform several types of craniotomy to remove acoustic neuromas. Surgical craniotomy approaches include the suboccipital, translabyrinthine approach and middle fossa approaches.
Non-surgical treatment options for acoustic neuromas:
Surgery for larger tumors is complicated by the probable damage to hearing, balance, and facial nerves. Another treatment option is radiosurgery, which uses carefully focused radiation to reduce the size or limit the growth of the tumor.
For patients with smaller acoustic neuromas, surgery and radiation therapy are equally effective. Doctors at Johns Hopkins generally recommend radiation therapy to treat older patients.
- Radiation therapy (radiotherapy and stereotactic radiosurgery) — For radiosurgery, single vs. fractionated (multiple smaller treatments rather than one large treatment) are options. The fractionated stereotactic radiosurgery (FSR) appears to offer very high rates of control with preservation of hearing and preservation of the facial strength.
- Observation — For some slow-growing acoustic neuromas observation with delayed treatment may be acceptable. This is a common treatment option for elderly or infirm patients with mild symptoms where the risks of therapy may be greater and where the tumor may not grow during their lifespan.
Post-surgical treatment for acoustic neuromas:
After treatment for acoustic neuroma, some patients experience hearing loss, cerebrospinal fluid leak, damage to the nerves in the face and other problems. Johns Hopkins offers comprehensive surgical treatment and rehabilitation care for all of these problems.
Surgical treatment for problems related to acoustic neuroma
Treatments for hearing loss: Baha speech processor and Cochlear implants
- Baha speech processor
The bone-anchored hearing aid (Baha) speech processor is a hearing aid that Johns Hopkins doctors surgically implant under the skin near the ear. The device grows into the skull bone and enhances the bone’s natural transmission of sound. The Baha speech processor transmits sound vibrations within the skull and inner ear that stimulate the nerves of the inner ear, enabling the patient to hear.
We may recommend a regular hearing aid instead of a Baha speech processor for some patients.
- Cochlear implants
Patients with neurofibromatosis 2 often develop acoustic neuromas in both ears. This results in severe hearing problems or deafness in both ears.
Cochlear implants can help provide a sense of sound to these patients and help them understand speech. The device consists of an external earpiece and a device that our doctors surgically implant under the skin near the ear.
Cochlear implants work by bypassing the damaged portions of the ear and directly stimulating the hearing nerve. They generate signals from the auditory nerve to the brain, which recognizes the signals as sound.
Repairing cerebrospinal fluid (CSF) leak
Cerebrospinal fluid leak is a common problem after surgical removal of an acoustic neuroma. Leaks are caused by a hole or tear in the dura. Our doctors closely monitor patients for cerebrospinal fluid leak. If this occurs, they perform a procedure to block the hole that is leaking cerebrospinal fluid.
Repairing facial nerve damage
If the patient’s facial nerves are damaged by the acoustic neuroma, Johns Hopkins plastic surgeons will be consulted. They perform procedures to help restore movement in the face.