To wait or to treat? If you’ve been diagnosed with an acoustic neuroma (a benign brain tumor, called a vestibular schwannoma), your doctor will discuss whether treatment is right for you.

Sometimes, doctors prefer to watch patients carefully instead of immediately turning to surgery to remove the brain tumor. Other times, surgery is necessary. Johns Hopkins neurosurgeon Rafael Tamargo, M.D., discusses four scenarios where he recommends treatment over watchful waiting.

Size

Size is one of the most important factors when Tamargo considers whether to treat an acoustic neuroma. If the brain tumor is greater than 20 mm to 25 mm at the time of diagnosis, treatment should be considered even if symptoms aren’t worrisome. That’s because as tumors become larger, surgery becomes more complex.

Severe Symptoms

It’s possible to have a larger acoustic neuroma with minor symptoms or a small tumor with incapacitating symptoms. In this case, the symptoms are the deciding factor.

When symptoms start to impact quality of life, Tamargo recommends treating a brain tumor, even if the tumor is small. These symptoms could include:

• Worsening balance problems
• Routine falls
• Facial pain

Tumor Growth

An acoustic neuroma can be very slow growing. Because of that, sometimes doctors choose to watch a tumor carefully over time. The primary way they do this is through regular imaging, often with MRI .

If Tamargo looks at subsequent MRIs of a brain tumor and sees that it’s growing, he may recommend treatment at that time. This will depend on several factors, including:

• How fast a tumor is growing
• The location and shape of a tumor
• A patient’s health and other characteristics

Symptom Progression

Besides tumor growth, worsening symptoms is another reason doctors may decide to stop watching a tumor and move to treatment. This is particularly true for balance symptoms.

If you’ve been diagnosed with an acoustic neuroma, and your doctor decides to monitor you, reach out to him or her if you:

• Notice your balance becomes more unsteady
• Are concerned about falling
• Notice facial pain or other new symptoms

Today, surgery can often treat these tumors well. Hearing loss (another common symptom) is hard to reverse. But many times doctors are able to reverse balance problems and other symptoms.