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Acoustic Neuroma: Treatment Options for Benign Brain Tumor

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Size matters — and it often directs how doctors treat brain tumors. This is particularly true for acoustic neuromas (or vestibular schwannomas). These are rare, benign (noncancerous) brain that commonly affect balance or hearing.

Johns Hopkins neurosurgeon Rafael Tamargo, M.D., explains how size can influence treatment — and why it’s important to choose a doctor who has an intimate knowledge of these specific tumors.

Acoustic neuroma size determines treatment

Acoustic Neuroma Treatment Options

If you’ve been diagnosed with an acoustic neuroma, your doctor will determine the best plan of action for you. This could include:

  • Surgery to remove the tumor
  • Stereotactic radiosurgery, which delivers precisely-targeted radiation to the tumor, so the radiation targets only the tumor and not the surrounding, healthy tissue
  • Observation, which means your doctor will monitor the tumor carefully through advanced imaging such as MRI, instead of starting treatment right away

A tumor’s size is one of the biggest factors that determine treatment. Yet there’s no standard way to measure an acoustic neuroma, so Tamargo says different doctors use different measurements. The problem is that these tumors look like an ice cream cone, with ice cream on top.

Because of this shape, that measurement will vary widely depending on whether a tumor is measured vertically or horizontally. Tamargo says the diameter of the “ice cream on top” is what matters and should determine how you’re treated. This is one reason it’s important to see a doctor who knows these tumors well.

Acoustic Neuroma Treatment: Microsurgical Advances

If your doctor recommends surgery to remove the acoustic neuroma, he or she will recommend an approach that takes into consideration:

  • The size of the tumor
  • Your age
  • Your health

Modern neurosurgery advancements have made these procedures safer and more effective. Often, surgeons can reverse certain symptoms, including balance problems.

Johns Hopkins doctors use surgical microscopes to magnify what they’re looking at, offering more precision for such specialized procedures. Two of the common neurosurgical approaches to remove acoustic neuromas include:

  • Suboccipital or retrosigmoid craniotomy: This is a minimally invasive approach to neurosurgery that is ideal for larger tumors. At Johns Hopkins, surgeons have a better chance of preserving a patient’s hearing with this approach.
  • Translabryrinthine craniotomy: This approach is generally considered for patients who have no functional hearing. During the surgery, part of the ear canal is removed, which would affect hearing.

Acoustic Neuroma Treatment: Choosing Your Care Team

Because these brain tumors are so rare, major medical centers tend to have more experience treating them. If you don’t live near a center where a doctor has treated hundreds of these specific tumors, then you should travel to a doctor who does.

Why? Studies show doctors who do more of a procedure perform it more effectively. That means the more acoustic neuromas a doctor treats, the better results he or she can offer you.

At Johns Hopkins, Tamargo and his team are continually improving their microsurgical approaches. In addition, every surgery (and treatment plan) is tailored to a particular tumor and made appropriate for a particular patient. That individualization optimizes success.

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