What is acoustic neuroma surgery?
An acoustic neuroma may be surgically removed by one of three different craniotomies: suboccipital, translabyrinthine, or middle fossa. The choice of a particular craniotomy depends on the tumor size, tumor position, and hearing status. The suboccipital craniotomy (also called retrosigmoid) involves removing a portion of the occipital bone behind the ear to remove the tumor.
Who needs acoustic neuroma surgery?
You may be a candidate for acoustic neuroma surgery if you have:
- A medium or large acoustic neuroma that is causing problems, especially balance problems caused by brainstem compression
- Serviceable hearing in the affected ear
- Neurofibromatosis type 2 (NF-2)
What should I expect prior to surgery?
You will have an office visit with a neurosurgeon, otologic surgeon, and an audiologist before surgery. An audiologist will perform a hearing test and a presurgical assessment of cranial nerve function. Discuss all medications (prescription, over the counter, and herbal supplements) you are taking with your healthcare provider. Some medications will need to be continued or stopped the day of the surgery. You will be scheduled for presurgical tests (e.g., a blood test, electrocardiogram, chest X-ray, and CT scan) several days before surgery.
During the office visit, the surgeon will explain the procedure, its risks and benefits, answer any questions, and give you instructions on pre-surgery preparations, which may include:
- Stopping medications
- Stop smoking and chewing tobacco
- Washing your hair with medicated soap
What should I expect during surgery?
There are 6 steps to the procedure, which generally takes 4-6 hours, depending on the tumor size.
You will lie on the operating table and be given anesthesia. The audiologist will attach electrodes to your face and ear to monitor the facial nerve, hearing, and brainstem functions during surgery.
The tumor origin at the vestibular nerve is cut, and attachments to the facial nerve are carefully dissected. After the tumor is removed, the internal auditory canal is sealed with bone wax, and a small piece of muscle is glued over the opening. This prevents cerebrospinal fluid (CSF) from leaking into the middle ear. The dura is closed in watertight fashion and biologic glue is applied to prevent CSF leakage. The bone flap is replaced and secured with titanium plates and screws. The muscles and skin incision are then rejoined and sutured together.
What should I expect after surgery?
A follow-up appointment with the neurosurgeon will be scheduled 10 to 14 days after surgery. Recovery times varies from 4 to 6 weeks, depending on the tumor size and your general health. Patients typically return to work in 6 weeks, provided their balance is recovery, but be sure to check with your surgeon.
Outcomes of surgery depend on the size and adherence of the tumor, the use of cranial nerve monitoring, and the skill of the surgical team. Removing the tumor will usually restore balance, facial function and sensation, eyelid function, and tear production. Hearing loss is usually permanent because the tumor is wrapped around the eighth cranial nerve (the nerve responsible for hearing).
What are the risk factors of surgery?
No surgery is without risk. General complications of any surgery include bleeding, infection, blood clots, and reactions to anesthesia. Specific complications related to a craniotomy may include stroke, seizures, venous sinus occlusion, swelling of the brain, and CSF leakage. Risks related to acoustic neuroma surgery may include:
- Facial weakness
- Temporary facial paralysis or weakness
- Permanent facial paralysis or weakness
- Certain eye problems
- Hearing loss
- Cerebrospinal fluid leakage
Contact your provider immediately if you experience:
- A temperature that exceeds 101.5 degrees Fahrenheit
- An incision that shows signs of infection, such as redness, swelling, pain, or drainage.
- Increased headache with nausea or vomiting, along with increased swelling at the incision site. Leaking cerebrospinal fluid may accumulate under the skin incision.
- Drowsiness, balance problems, or rashes.
- Decreased alertness, increased drowsiness, weakness of arms or legs, increased headaches, vomiting, or severe neck pain that prevents lowering your chin toward the chest.