From the Guidelines
Treatment for acoustic neuroma should prioritize stereotactic radiosurgery (SRS) for small, slow-growing tumors, as it offers high rates of tumor control and hearing preservation with minimal risk of facial nerve damage, as supported by the most recent and highest quality study 1. The management of acoustic neuroma, also known as vestibular schwannoma, involves a range of treatment options including observation, SRS, and surgical removal.
- Observation with regular MRI monitoring is often recommended for small, asymptomatic tumors, with scans every 6-12 months to monitor growth.
- SRS, such as Gamma Knife or CyberKnife, delivers precise radiation to stop tumor growth while preserving surrounding tissue and is typically used for tumors smaller than 3 cm.
- Surgical removal options include translabyrinthine, retrosigmoid, and middle fossa approaches, with the specific technique chosen based on tumor size, hearing status, and patient factors. The choice between these options depends on tumor size, growth rate, patient age, overall health, hearing status, and symptoms, and should balance tumor control against potential complications like hearing loss, facial nerve damage, balance problems, and headaches, as noted in 1. SRS is a noninvasive treatment with at least equivalent rates of tumor control and hearing preservation as compared to microsurgical resection, with the added benefit of better facial nerve preservation, making it a preferred option for many patients 1. In cases where surgery is necessary, the goal should be total or near-total resection, as residual tumor volume correlates with the rate of recurrence, and intraoperative monitoring is mandatory to improve functional preservation, as discussed in 1. Ultimately, the decision on the best course of treatment for acoustic neuroma should be made on a case-by-case basis, taking into account the individual patient's unique circumstances and priorities, and guided by the most recent and highest quality evidence available, such as the study published in 1.
From the Research
Treatment Options for Acoustic Neuroma
The treatment options for acoustic neuroma include:
Comparison of Treatment Options
Studies have compared the outcomes of microsurgery and stereotactic radiosurgery for acoustic neuroma:
- Stereotactic radiosurgery was found to be more effective in preserving normal postoperative facial function and hearing preservation, with less treatment-associated morbidity 3
- Radiosurgery can provide long-term control of acoustic neuromas while preserving neurologic function 2
- Microsurgery is considered the treatment of choice, but radiosurgery is a valid alternative in selected patients, such as the elderly, those with comorbidity, small tumor size, and sensorineural hearing loss 4
Challenges of Surgical Salvage
Surgical salvage after failed radiation therapy can be challenging due to:
- Increased fibrosis and adhesion to adjacent nervous structures
- Excessive scarring that hinders identification of the facial nerve
- Uncertainty as to the completeness of tumor removal 6
- Poorer outcomes of postoperative cranial nerve status due to anatomic changes at the nerve/tumor interface 6
Perioperative Care
Perioperative care of patients with acoustic neuroma is crucial, and nurses play a significant role in the care of these patients:
- Patients with acoustic neuroma require careful assessment and monitoring during the perioperative period 5
- Complications such as cerebrospinal fluid leakage, damage to ancillary brain structures, facial nerve damage, and bleeding or vascular injury can occur, and nurses should be aware of these potential complications 5