Acoustic Neuroma: Diagnosis and Treatment Options

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					                                                       ACOUSTIC NEUROMA




Acoustic Neuroma
Diagnosis and Treatment Options
BY DAVID S. HAYNES, M.D., FACS




A
            n acoustic neuroma, otherwise known as a vestibular          tively common, they do not normally occur just in one ear. When
            schwannoma, is a benign tumor affecting the eighth           they do, this alerts the healthcare provider that there is a potential
            cranial nerve, which consists of two divisions – the hear-   acoustic neuroma, the diagnosis of which is confirmed via mag-
            ing, or cochlear, division and the balance, or vestibular,   netic resonance imaging (MRI). The addition of gadolinium, a
            division. Acoustic neuromas generally arise from the         contrast agent, during the MRI allows for the diagnosis of tumors
            balance, or vestibular, division of the nerve. All tumors    as small as one millimeter.
can be classified as either benign or malignant, with benign tumors
having a tendency to be less locally invasive with no potential to   Treatment
spread throughout the body. Acoustic tumors are clearly benign       Once a diagnosis of an acoustic neuroma is made, several diverse
with no malignant potential and are relatively slow-growing.         treatment options exist for the patient. These include observa-
                                                                     tion, microsurgical excision and stereotactic radiosurgery. Many
Diagnosis                                                            variables should be considered prior to selecting treatment. These
Acoustic neuromas affect two out of every 100,000 persons. They      include age, hearing status, tumor size and growth rate, health sta-
are most commonly diagnosed in people between the ages of 30         tus, and other medical conditions. Because acoustic neuromas are
and 60. No environmental causes have been found and, as these        slow-growing and benign tumors, the recommendations for treat-
tumors are nonhereditary, there is no risk of passing the propensity ment vary between physicians and medical centers based on their
to develop the tumor to an offspring. Similarly, the affected per-   outcomes and experiences. It is not uncommon for a patient to re-
son’s parents, siblings and offspring are at no greater risk of hav- ceive differing recommendations for treatment following a second
ing an acoustic neuroma. Only persons with bilateral (both sides)    opinion, often leading to confusion on the part of the patient.
acoustic neuromas – a rarer disorder called neurofibromatosis type       If observation is chosen, an MRI should be performed every
II (NF2) – have a hereditary risk. A genetic defect in the form of   year until a growth rate is established. If significant growth is de-
a lack of a specific tumor suppressor gene that leads to the devel-   termined or if symptoms progress, the possibility of intervention
opment of these tumors has been identified. As mentioned, this        (surgery or radiosurgery) can be entertained. The aim of observa-
defect is not passed on to offspring.          
				
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