Test of hearing and brainstem function (brainstem auditory evoked response)
Treatment depends on the size and location of the tumor, your age, and your overall health. You and your health care provider must decide whether to watch the tumor (observation), use radiation to stop it from growing, or try to remove it.
Many acoustic neuromas are small and grow very slowly. Small tumors with few or no symptoms may be watched for changes, especially in older patients. Regular MRI scans will be done.
If they are not treated, some acoustic neuromas can damage the nerves involved in hearing and balance. They can also affect the nerves responsible for movement and feeling in the face. Very large tumors can lead to a buildup of fluid (hydrocephalus) in the brain, which can be life threatening.
Removing an acoustic neuroma is more commonly done for:
Tumors that are causing symptoms
Tumors that are growing quickly
Tumors that are pressing on the brain
Surgery is done to remove the tumor and prevent other nerve damage. Any hearing that is left is often lost with surgery.
Stereotactic radiosurgery focuses high-powered x-rays on a small area. It is considered to be a form of radiation therapy, not a surgical procedure. It may be used:
To slow down or stop the growth of tumors that are hard to remove with surgery
To treat patients who are unable to have surgery, such as the elderly or people who are very sick
Removing an acoustic neuroma can damage nerves, which may cause loss of hearing or weakness in the face muscles. This damage is more likely to occur when the tumor is large.
An acoustic neuroma is not cancer. The tumor does not spread (metastasize) to other parts of the body. However, it may continue to grow and press on structures in the skull.
People with small, slow-growing tumors may not need treatment.
Once hearing loss occurs, it does not return after surgery or radiosurgery.
Brain surgery can completely remove the tumor in most cases.
Most people with small tumors will have no permanent paralysis of the face after surgery. However, about two-thirds of people with large tumors will have some permanent weakness of the face after surgery.
About one-half of patients with small tumors may still be able to hear in the affected ear after surgery.
There may be delayed radiation effects after radiosurgery, including nerve damage, loss of hearing, and paralysis of the face.
When to Contact a Medical Professional
Call your health care provider if you have:
Hearing loss that is new or getting worse
Ringing in one ear
Baloh RW, Jen J. Hearing and equilibrium. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 430.
Brackmann DE, Arriaga MA. Neoplasms of the posterior fossa. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, PA: Mosby Elsevier; 2010:chap 177.
Battista RA. Gamma knife radiosurgery for vestibular schwannoma. Otolaryngol Clin North Am. 2009;42:635-654.
Sweeney P, Yajnik S, Hartsell W, Bovis G, Venkatesan J. Stereotactic radiotherapy for vestibular schwannoma. Otolaryngol Clin North Am. 2009;42:655-663.
Conley GS, Hirsch BE. Stereotactic radiation treatment of vestibular schwannoma: indications, limitations, and outcomes. Curr Opin Otolaryngol Head Neck Surg. 2010 Oct;18(5):351-6.
Ashutosh Kacker, MD, BS, Professor of Clinical Otolaryngology, Weill Cornell Medical College, and Attending Otolaryngologist, New York-Presbyterian Hospital, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.