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Acoustic Neuroma Removal

Definition | Reasons for Procedure | Possible Complications | What to Expect | Call Your Doctor

Definition

An acoustic neuroma is a benign (noncancerous) tumor. It grows on the acoustic nerve which runs from the brain to the ear. This type of tumor typically grows slowly. It may cause hearing loss, balance problems, facial numbness, and headaches.

The Acoustic Nerve

There are three main treatment options for an acoustic neuroma:

Careful monitoring
Radiation therapy
Microsurgical removal

This fact sheet focuses on microsurgical removal.

Reasons for Procedure

Increasing growth of the tumor
Concern that tumor size may become life-threatening
Tumor is causing hearing problems

A successful procedure results in complete removal of the tumor with minimal additional hearing loss.

Possible Complications

Side effects may be temporary or permanent. If you are planning to have this surgery, your doctor will review a list of possible complications which may include:

Hearing loss
Excessive eye dryness
Difficulty with balance
Ringing in your ears (Tinnitus)
Facial weakness and numbness on the side of the tumor
Headaches
Infection
Bleeding

Some factors that may increase the risk of complications include:

Your age
Size of the tumor

What to Expect

Prior to Procedure

The following medications may be given before the procedure:

Steroids—usually started 48 hours before surgery
Antibiotic—given by IV (into the vein) right before surgery

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure like:

Aspirin or other anti-inflammatory drugs
Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)

Anesthesia

General anesthesia will be used. You will be asleep.

Description of the Procedure

The type of procedure will depend on your case. Factors such as hearing status and the size and location of the tumor will be considered. One of the following surgical methods will be selected:

Translabyrinthine

This is often used you are already having significant hearing loss. The mastoid bone (part of skull) and bone in the inner ear will be removed. This allows access to the ear canal and the tumor.

Retrosigmoid/Sub-occipital

An opening will be made in the skull behind the ear. This approach is used for large or small tumors. This process will make it easier to see and protect the nerves during surgery.

Middle Fossa

The tumor will be removed from the upper surface of the ear canal. This is used when there is a good chance that hearing may be preserved.

Immediately After Procedure

You will spend at least one night in the intensive care unit for care and observation.

How Long Will It Take?

The surgery takes about 6-12 hours. The exact length will depend on the size and location of the tumor.

How Much Will It Hurt?

Anesthesia will prevent pain during the procedure. You may notice pain after the procedure. Talk to your doctor about medicines to help manage the pain.

Average Hospital Stay

The usual length of stay is 4-7 days. Your stay may be longer if there are complications.

Post-procedure Care

At the Hospital

During recovery, you may have some of the following:

Head discomfort
Fatigue and sleepiness
Emotional lows
Headache
Dizziness
Nausea

Staff will help you manage these problems.

At Home

Be sure to follow your doctor’s instructions.

Keep the incision area clean and dry.
Do not drive until your doctor allows it.
Ask your doctor when you will be able to return to work.
Take medications as instructed.

Full recovery typically takes 4-6 weeks. MRI scans will be done regularly over the next several years. The scans will check to see if the tumor returns.

Call Your Doctor

After you leave the hospital, contact your doctor if you have:

Signs of infection, including fever, chills, and neck stiffness
Worsening headache
Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
Nausea and/or vomiting that you can't control with the medications you were given after surgery or that persists for more than two days after discharge from the hospital
Pain that you can't control with the medications you've been given
Cough, shortness of breath, or chest pain
Stiff neck
Runny nose

In case of an emergency call 911.

RESOURCES:

American Hearing Research Foundation http://www.american-hearing.org/
National Institute on Deafness and Other Communication Disorders http://www.nidcd.nih.gov/

CANADIAN RESOURCES:

The Canadian Hearing Society http://www.chs.ca/
Canadian Society of Otolaryngology http://www.entcanada.org/

References:

Acoustic Neuroma Association website. Available at: http://anausa.org/ .
Bennett M, Haynes DS. Surgical approaches and complications in the removal of vestibular schwannomas. Otolaryngologic Clinics of North America . 2007;40(3):589-609.
International Radiosurgery Association website. Available at: http://www.irsa.org/ .

Last reviewed October 2009 by Rimas Lukas, MD and Brian P. Randall, MD

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