Technique For Removal of Acoustic Neuromas Tumors

New technology has made it possible to remove acoustic neuromas tumors with minimally invasive techniques. Acoustic neuromas (vestibular schwannoma) are benign or non-cancerous tumors growing on the nerve connecting the ear to the brain. The tumor presses against this nerve which is responsible for hearing and balance.

There are several new and older technologies that allow patients to receive treatment and be discharged in as little as 48 hours. The most common procedures and approaches include: Endoscopic endonasal approach, endoscopic approach, translabyrinthine approach and gamma knife. Each approach will be discussed in brief.

Endoscopic Endonasal Approach
The Endoscopic Endonasal Approach (EEA) removes tumors and lesions by entering the nasal passages. The approach involves a team of neurosurgeons, ophthalmic surgeons, otolaryngologists and spine surgeons to successfully complete the surgery. This minimally invasive technique uses the endoscope to illuminate the tumor and leading edge instruments for dissection and tumor removal. This method is preferred because patients experience no facial incisions, fewer side effects, less trauma to brain and critical nerves and shorter recovery times.

Endoscopic Approach
This minimally invasive approach involves drilling a hole this size of a dime in the mastoid bone of the skull. The endoscopic approach may be combined with a small tube called the Neuroendoport to guide the endoscope to the tumor. The two devices together allow surgeons to capture excellent images of the tumor thanks to the powerful endoscope light source. The tumor can be removed, and the patient can return home in 48 hours. Faster recovery times are possible because the brain is not pushed, retracted or manipulated.

Endoscopic approach is effective because it provides accurate information about the location of the tumor relevant to adjacent structures. When surgeons accurately identify the facial and cochlear nerves, complete tumor removal is possible. The technique has not been proven to preserve hearing any more than any other procedure, but it is one the most effective methods for removing tumors completely.

In one study, 82 percent of the patients with some hearing prior to the surgery maintained the same level of hearing or better after the surgery. One hundred percent of the patients maintained facial nerve function with no paralysis.

Translabyrinthe Approach
The translabyrinthe approach is effective on large tumors. The method is often combined with retrosigmoid subtemporal craniotomy to avoid damage to healthy tissue and to the facial nerve. A hole is drilled through the mastoid and labyrinth or inner ear. The tumor can be removed once access to the posterior fossa is gained.

Gamma Knife
Gamma knife is used when patients are resistant to surgery. The treatment is also the first option when the tumor is not causing “mass effect.” When tumors are small, this method is more likely to preserve hearing. This form of treatment radiates the tumor and obliterates the mass.

Ask Your Neurologist About the Latest Techniques
Though these are not the only techniques used for acoustic neuroma tumors, the techniques are some of the most innovative and effective. Patients considering acoustic neuroma surgery should contact their physician or surgeons to determine the best technique.