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An acoustic neuroma is a non-cancerous lesion that occurs on the eighth cranial nerve. This is the nerve that connects the inner ear with the brain. It has two functions: the first has to do with hearing and the second has to do with having balance. An acoustic neuroma goes by several other names: a vestibular schwwannoma or a neurolemmoma. It tends to grow slowly over a period of years. They don’t grow into the brain but they do push on the brain as they grow. Larger tumors will press on the nearby cranial nerves that control the muscles that control facial expression and sensation of the face. Acoustic neuromas can be deadly if they become large enough to press on the brainstem or cerebellum.
In the beginning, acoustic neuromas have subtle symptoms. People feel as though they represent simple symptoms of aging so it can take a bit before the condition is diagnosed. The initial symptom is a gradual loss of hearing in one ear with ringing in the ear. In rare cases, it can cause a sudden loss of hearing. As the tumor grows, other symptoms can occur, including:
If the doctor fails to recognize these symptoms and the acoustic neuroma grows, death can be the outcome.
There are two kinds of acoustic neuroma. The first is sporadic and can occur in anyone. The second type is related to having neurofibromatosis type II. This is an inherited disease that often has growths of a noncancerous type of the nervous system. Acoustic neuromas are the most common kind of these non-cancerous tumors and they often occur in both ears by the age of thirty years. Neuro-fibromatosis type II is rare so it accounts for only 5 percent of acoustic neuromas. So many more acoustic neuromas are sporadic. Doctors don’t know why people get the sporadic form of the disease. They do know that people exposed to high doses of radiation have an increased risk of getting an acoustic neuroma.
Treatment of acoustic neuroma may involve simple observation, surgery or radiation therapy. It is acceptable to watch and wait in the case of a small acoustic neuroma because they are not cancerous and grow slowly. An MRI can monitor the growth to see how fast it changes over time. If symptoms worsen, a neurosurgeon can perform surgery and remove the acoustic neuroma. Sometimes the whole neuroma isn’t removed because it’s too near delicate nerves. There is a newer, less invasive surgical technique called a total endoscopic resection. It enables surgeons to remove acoustic neuromas using a tiny camera inserted through a hole in the skull. There are only a few surgeons who are adept at this technique.
Radiation therapy is recommended for some people who have an acoustic neuroma. There are several state of the art techniques that make it possible to blast the acoustic neuroma with high doses of radiation while limiting exposure and possible damage to surrounding tissue.
Radiation is delivered in either of two ways: Single fractionated stereotactic radiosurgery. This involved hundreds of small beams of radiation aimed at the tumor in a single session. There is multi-session fractionated stereotactic radiotherapy. In this type of therapy, there are smaller doses of radiation given daily over several weeks. It seems to preserve hearing better than the first type.
Choosing the right treatment depends on the size of the tumour, the person’s age, whether the tumour is growing faster than average, the severity of the symptoms the person is having and other medical problems the patient may have.
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