Overview: Acoustic neuroma (vestibular schwannoma or Cerebellopontine angle tumor or Angle tumor) is a noncancerous (benign tumor) that develops on the main nerve leading from inner ear to brain. The cells that form an acoustic neuroma are called Schwann cells and make up the lining of the eighth cranial nerve as it passes through a tiny canal, which connects the inner ear to the brain. Acoustic neuroma typically grows slowly or not at all, but in a few cases it may grow rapidly and become large enough to press against the brain and interfere with the vital functions. Because branches of this nerve directly influence your balance and hearing, pressure from an acoustic neuroma can cause hearing loss, ringing in your ear and unsteadiness.
Symptoms of Acoustic Neuroma:
Early symptoms are easily overlooked, thus making diagnosis a challenge. There usually are symptoms, however, indicating the possibility of an acoustic neuroma. The first symptom in 90% of those with a tumor is a reduction in hearing in one ear, often accompanied by ringing in the ear or tinnitus. The loss of hearing is usually subtle and worsens slowly, although occasionally a sudden loss of hearing is noted. There may be a feeling of fullness in the affected ear. These early symptoms are sometimes mistaken for normal changes of aging, or attributed to noise exposure earlier in life and therefore the diagnosis is often delayed.
Other Less common symptoms include:
Difficulty understanding speech
Loss of balance
Numbness in the face or one ear
Pain in the face or one ear
Weakness of the face
Types of Acoustic Neuroma:
There are two types of acoustic neuromas:
Unilateral Acoustic Neuromas - Unilateral acoustic neuroma affects only one ear. This type accounts for approximately 8 percent of all tumors inside the skull. One out of every 100,000 individuals per year develops an acoustic neuroma. Symptoms may develop at any age, but usually appear between the ages of 30 and 60. This is not a hereditary condition.
Bilateral Acoustic Neuromas - Bilateral acoustic neuromas affect both ears and are hereditary, caused by a genetic disorder called neurofibromatosis-2 (NF2). This tumor develops in the teens or early adulthood. In addition, patients with NF2 usually develop multiple brain and spinal cord related tumors.
Causes of Acoustic Neuroma:
The cause is unknown. Acoustic neuromas can be sporadic or caused by an inherited condition called neurofibromatosis type 2 (NF-2) (also known as von Recklinghausen's disease). Acoustic neuromas have a 5 percent association with von Recklinghausens's disease (NF-2), a rare disease characterized by multiple tumors in various sites, especially the skin, which can cause bilateral acoustic tumors.
Diagnosis of Acoustic Neuroma:
If your doctor suspects acoustic neuroma, he may recommend several tests to diagnose acoustic neuroma. These tests are:
Hearing test (audiogram)
Computerized tomography (CT) scans, enhanced with intravenous dye (contrast)
Magnetic resonance imaging (MRI), enhanced with intravenous dye (contrast).
These acoustic neuroma tests are critical in the early detection of an acoustic neuroma and are helpful in determining the location and size of a tumor and in planning its removal.
Preparation for Acoustic Neuroma Surgery:
Surgery for acoustic neuroma is performed on an inpatient basis, which means you will stay in the hospital after the procedure. In some cases, you may also need to stay overnight before the procedure.
You will be given specific instructions as to where and when to arrive at the medical facility, how to prepare for your surgery, and what to expect the day of and the days following your procedure. In addition, you will be asked not to eat or drink anything for at least eight hours beforehand.
Because you will not be able to drive for some time after acoustic neuroma surgery, be sure to arrange for someone to drive you home on the day you leave the hospital.
Acoustic Neuroma Surgery:
The options open to Acoustic Neuroma patients are basically:
Watch & Wait (no treatment)
Surgery - An operation to remove an acoustic neuroma is a specialized procedure, as it involves surgery inside the inner ear, and sometimes inside the skull, depending on the exact location of the tumour. Once the tumour has reached a size where symptoms are becoming problematic, surgery may be the only choice available. The actual surgery involves microsurgery and neurosurgery, as well as a general anaesthetic. Surgery may be performed via three routes
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.
Radiation - Focused beam radiation (e.g. the Gamma knife) has been greatly advocated as a new technology for benign brain tumors, especially the acoustic neuroma. The goal of the treatment is to kill or inactivate the tumor cells so they no longer duplicate. Since acoustic neuroma is a very benign type of tumor, it need not be completely destroyed. Instead, the aim is to stop further growth. An acoustic tumor that does not grow will not jeopardize the patient's health in the future.
Observations “Wait n Watch” - Some tumours are very small and because we know they are slow growing, there is an option to "watch" the tumour. This is done through serial MRIs. If and when growth is observed, option 1 and 2 and re explored.
Types ofAcoustic Neuroma Surgery: The exact type of operation done depends on many factors. The most significant are the size of the tumor and the level of hearing in the affected ear. If the tumor is very small, hearing may be saved and accompanying symptoms may improve. As the tumor grows larger, surgical removal is more complicated and hearing and balance may be lost. The facial nerve accompanies the nerves of hearing and balance along their course from the brain through the ear and this is a very important nerve to protect during microsurgery. The preservation of the facial nerve is of utmost importance, and is more of a priority than the patients hearing. The three approaches to remove an acoustic neuroma are:.
Retrosigmoid Approach: The surgeon opens the skull about three inches behind the ear. The cerebellum, the part of the brain surrounding the acoustic neuroma, is gently retracted to expose the tumor. The advantage of this approach is that hearing can sometimes be preserved. This is also called the sub-occipital approach.
Middle Fossa Approach: An opening is created above the ear, and the surgeon drills toward the tumor while staying outside the dura covering of the brain. Bone is removed over the internal auditory canal to expose the tumor. This approach most often used when preservation of hearing is a primary goal.
Translabyrinthine Approach: This approach may be used when the patient has no remaining hearing in the ear, or when other approaches are not feasible. The surgeon drills immediately behind the outer ear and removes bone with the goal of exposing the tumor as completely as possible. The advantage of this method is that no part of the brain need be retracted, and the facial nerve can easily be seen.
Follow-Up Care Post Acoustic Neuroma Surgery:
Follow-up care after the surgery for acoustic neuroma is important. During the follow-up period after acoustic neuroma surgery, the doctor will monitor your recovery and check for a recurrence of your symptoms. Checkups help ensure that any changes in your health are noted and treated if needed. Between scheduled visits, you should contact the doctor if you have any health problems.
Benefits of Acoustic Neuroma Surgery: With the advancement of medical technology, dedicated physicians can now offer hope and help patients by offering the most effective, least invasive treatments for acoustic neuroma surgery.
Observation or watchful waiting can help avoiding surgery and exposure to radiation. If the patient and his family members stay vigilant and keep an eye on the status of the disease, there may not arise any need for surgery or radiation therapy. But with advanced stage of Acoustic Neuroma surgery can be a source of great relief for the patients. Through surgery tumour can be completely removed with remote risk of recurrence. After surgery only one follow up MRI would be needed. There are minimal long-term side-effects. Radiation therapy for Acoustic Neuroma helps controlling small tumours and the control rate is approximately 80-90% with less than 5- 6 years of follow up. Radiation therapy also helps in quick recovery and the stay in the hospital is usually short. Surgery and treatment of Acoustic Neuroma can help patients to resume their normal daily living depending on the size of the tumour.
Complications: There are various possible complications after Acoustic Neuroma surgery like Balance Problems, weakness of the face, numbness, headaches, taste and swallowing Problems, dry eyes, etc.
Acoustic Neuroma Surgery in India: Indian medical professionals are trained in nervous system conditions, brain surgery, hearing and balanced disorders. These experts attract over a million people in India every year. They have huge experience in diagnosing and treating brain and nervous system conditions. There are internationally trained neuro-oncologists for tumour treatment, otolaryngologists for ear, nose and throat conditions, audiologists for hearing conditions, radiologists for imaging and other doctors and surgeons. All these facilities make India a desirable destination for Acoustic Neuroma Surgery.
Also India offers some of the best hospitals and medical centers of the world which has high-class infrastructure, hi-tech apparatus, a team of specialists, health professionals and nurses known for their compassion and dedication towards the service of their patients. Accommodation has never been a problem in India. As medical tourism is booming in India and has become an industry, the overall infrastructure has also developed and improved remarkably. There are several state-of-the-art hotels, resorts and lodges all around India.
Cities in India that offers Acoustic Neuroma Surgery at some of the best hospitals are as follows;
Cost of Acoustic Neuroma Surgery in India:
India is widely popular for the low cost treatment it offers for various medical and health related problems. The cost of Acoustic Neuroma surgery in some of the best hospitals in India is barely half the amount charged by hospitals of US, UK, and other developed countries. People usually travel from developed countries to India to avail such affordable treatment options, which is an impossible dream in their own country. Even travel and accommodation is very reasonable with world-class hotels and travel services. Low-cost does not affect the quality of service offered by hospitals and medical professionals. There is no compromise on quality care. This has satisfied many medical care- seekers from all around the globe.
Some of the common countries from which patients travel to India for surgery are:
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