Definition

An acoustic neuroma is a benign (noncancerous) tumor on the acoustic nerve leading from the brain to the ear. Acoustic neuromas grow relatively slowly, and may cause hearing loss, balance problems, facial numbness, and headaches.

The Acoustic Nerve

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There are three main treatment options for an acoustic neuroma:

This fact sheet focuses on microsurgical removal of an acoustic neuroma.

Parts of the Body Involved

  • Ear canal
  • Head
  • Brain

Reasons for Procedure

  • Increasing growth of the tumor
  • Concern that tumor size may become life-threatening
  • Hearing problems

Risk Factors for Complications during the Procedure

  • Age of the patient
  • Size of the tumor

What to Expect

Prior to Procedure

You will take the following medications:

  • Steroids—usually started 48 hours before surgery
  • Antibiotic—given intravenously (into the vein) right before surgery, and continued for 24 hours after surgery

During Procedure

You will be given IV fluids, antibiotics, and anesthesia.

Anesthesia

General anesthesia will be used. You will be asleep for the procedure.

Description of the Procedure

Depending on your hearing status and the size and location of the tumor, your doctor will select one of the following surgical methods to remove the acoustic neuroma:

  • Translabyrinthine—the doctor removes the mastoid bone and bone in the inner ear for access to the ear canal and the tumor. This approach is often used when hearing is already minimal.
  • Retrosigmoid/Sub-occipital—an incision is made through an opening in the skull, behind the mastoid part of the ear. This approach is used for large or small tumors, and makes it easier for the surgeon to view the facial nerve and to save the hearing.
  • Middle fossa—The tumor is removed from the upper surface of the internal ear canal beyond the inner ear. This approach is used when there is a good chance that hearing may be preserved.

After Procedure

You will spend at least one night in the intensive care unit for care and observation. During recovery, you may experience some of the following:

  • Head discomfort
  • Fatigue and sleepiness
  • Emotional "lows"
  • Headache
  • Dizziness
  • Nausea

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.

Will It Hurt?

Anesthesia will prevent pain during the procedure.

Possible Complications

Side effects may be temporary or permanent. They include:

  • Hearing loss
  • Excessive eye dryness
  • Difficulty with balance
  • Tinnitus
  • Facial weakness and numbness on the side of the tumor
  • Headaches
  • Cerebrospinal fluid leak. This may present as clear fluid leakage from the nose, or fluid collecting under the incision.

Average Hospital Stay

Recovery time in the hospital will take 4-7 days.

Postoperative Care

Full recovery typically takes 4-6 weeks.

Outcome

Successful completion of the surgery results in complete removal of the tumor, and minimal additional hearing loss. You should have MRI scans regularly over the next several years to check for recurrence.

Call Your Doctor If Any of the Following Occurs

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision site
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting
  • Neck stiffness
  • Runny nose