Acoustic Neuroma
What is acoustic neuroma surgery?
Surgery is the most definitive way of curing this tumour. However, given that these tumours occur in such a crucial location, surgery is difficult and high risk. Surgeons who specialise in this form of surgery are regarded as being in the pinnacle of their specialty.
Neurosurgeons are experts at dealing with fine and delicate structures such as the cranial nerves, brain stem and blood vessels. ENT (Ear Nose and Throat) surgeons are most familiar with the internal ear canal and the hearing and balance organs. It therefore makes sense that this surgery be carried out by a team composed of a Neurosurgeon and an ENT surgeon who are highly specialised and have considerable experience in this field of surgery.
Surgery maybe performed via three routes
- Retrosigmoid
- Translabrynthine
- Middle Fossa
The choice of approach is largely dependent on the surgeons’ choice followed by the presence of useful hearing and the size and position of the tumour.
When is acoustic neuroma surgery recommended?
The recommendation of surgery depends on the following factors:
- Age of patient
- Symptoms
- Size of tumour
- Growing tumour
How Should I Prepare for acoustic neuroma surgery?
- Discuss the procedure, risks, benefits, and expected outcomes with your surgical team
- Attend appointments with Ear Nose and Throat Surgeon
- Attend appointments with Balance specialist
- Sign consent form
- Attend all preoperative appointments and imaging studies
- Inform your doctor about medications, allergies, and medical conditions
- Stop certain medications, such as blood thinners, supplements, and fish oil
- Follow fasting instructions carefully
- Arrange transportation and support for recovery
What Happens During acoustic neuroma surgery?
What Happens After acoustic neuroma surgery?
After acoustic neuroma surgery, patients are monitored in the intensive care unit for complications such as swelling, bleeding, or neurological changes. Doctors assess speech, movement, memory, and overall brain function. Pain medications and steroids may be prescribed. Imaging scans are performed the next day to evaluate tumour removal and exclude complications. Hospital stay is in the order of 5-7 days. Recovery time varies, and rehabilitation may be needed for some patients.
What are the benefits of acoustic neuroma surgery?
- Complete resection cures the tumour
- Relieve compression of brainstem
- Relieve symptoms of dizziness/vertigo
- Aim to preserve cochlear nerve to enable potential for cochlear implant
What are the Risks and Complications of acoustic neuroma surgery?
- Post op haematoma
- Infection (brain, CSF, wound, urine, chest)
- Cerebrospinal fluid (CSF) leak
- Nerve damage which may cause:
- Hearing loss (90-100% chance)
- Dizziness/vertigo
- Facial paralysis
- Brainstem or vascular injury leading to stroke (Extremely rare)
- Hydrocephalus (accumulation of brain fluid)
- Complications related to other medical conditions (heart, lungs, kidney)
- Clots in legs (Deep venous thrombosis) and clots in lungs (pulmonary embolus)
- Reactions to anaesthesia
What can I expect when I am discharged from hospital
- You may experience pain (including headache), inflammation, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed.
- You may experience facial paralysis which causes the inability to shut your eye and a droopy lip. Eye care will be prescribed and must be strictly followed.
- You may experience dizziness and unsteadiness of walking. Exercises will be prescribed for this by physiotherapists.
- You will experience hearing loss which can be difficult to get used to.
- Keep the surgical site clean. Instructions on surgical site care and bathing will be provided.
- Refrain from smoking and alcohol until your first follow up visit as it can negatively affect the healing process.
- Refrain from lifting anything heavier than 5 Kg and other strenuous activities until the first follow-up visit. These activities may include housework, yard work, gardening, mowing, etc.
- Gentle exercise and regular walking are recommended to improve strength and endurance from 2 weeks after surgery.
- Refrain from driving until you are fully fit and receive your surgeon’s clearance.
- Most patients can return to their normal daily routines in 4-6 weeks after surgery.
