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NeuroLogic - Coming together for vestibular schwannomas

NeuroLogic Fall 2010

Coming together for vestibular schwannomas

Date: November 1, 2010

Rafael Tamargo and colleagues in neurosurgery and otolaryngology–head and neck surgery work together in the delicate task of resecting vestibular schwannomas.
Rafael Tamargo and colleagues in neurosurgery and otolaryngology–head and neck surgery work together in the delicate task of resecting vestibular schwannomas.

They may be technically benign, but tumors that form within the myelin-producing cells of the vestibulocochlear nerve can launch life-altering hearing deficits, balance problems, tinnitus, numbing of the face and difficulty walking—and in advanced cases they can even cause death. Known as vestibular schwannomas or acoustic neuromas, these rare tumors affect only one out of every 100,000 people worldwide, yet for neurosurgeon Rafael Tamargo, not a week goes by that he doesn’t see at least one patient with the condition.

This extensive body of experience helps Tamargo and his team to develop the most effective treatments for each patient. When new patients arrive for a consultation, they meet with what Tamargo calls the “three legs of the stool”—neurosurgeons, otologists and radiation oncologists—who discuss treatment options together and decide on the best choice.

The time-honored curative approach to these tumors is surgery, says John Niparko, interim director of the Department of Otolaryngology–Head and Neck Surgery. Physicians from this department work alongside Tamargo and his colleagues in the operating room to resect these often complex lesions, which almost invariably are pressing on the facial nerve—a pivotal player in expressing emotion, maintaining tone of the mouth, and eye closure—when they’re discovered.

“Because these tumors are in such a delicate anatomical area that carries out immensely important functions, the expertise that needs to be brought to them is considerable,” Niparko says. He and his colleagues often perform the bony dissection, then work in tandem with Tamargo and his team to dissect the lesion off a patient’s nerves.

In cases when surgery is not possible—for example, in patients who are older or at risk of complications from anesthesia—focused radiation therapy is another option. Older patients with small tumors may be advised to simply watch and wait. Many vestibular schwannomas grow very slowly, with patients more likely to die of other causes than these tumors.

Tamargo and Niparko emphasize that a goal of surgery or radiation is to help patients retain their hearing ability. However, in cases when hearing becomes permanently damaged on the side of the tumor, the primary treatment is an osteointegrated implant, a small sound processor on a titanium post that’s permanently implanted in the skull behind the ear. The processor samples the local sound environment, sending signals through the skull to the working ear’s auditory nerve.

“Patients whose vestibular schwannomas have wiped out hearing on one side often feel like they’re missing half the world—they can’t attend to sounds on the deaf side, and people they interact with sometimes think they’re rude, confused or out of touch,” Niparko says. “We give them back that half.”

That collaborative approach and extensive experience, agrees Tamargo, are key: “With a full team, we have great results. The more you treat the same condition, the better the outcomes will be—that’s been shown time and time again in other areas of medicine.”

For information: 410-614-1533