Acoustic Neuroma

An acoustic neuroma is a benign tumour that develops in the vestibular nerve, which lies very close to the auditory nerve .Acoustic neuroma account for about 8 in 100 of all primary brain tumours. Acoustic neuroma is a benign primary intracranial tumor of the myelin forming cells which cover the nerve called " Schwann cells" Actually it is misnomer since the tumor never arises from the acoustic division of the vestibulocochlear nerve. Most commonly acoustic neuroma arises from the covering cells (Schwann cells) of the inferior vestibular nerve. The various names used for this benign tumor include acoustic neuroma, acoustic neuronoma and vestibular schwannoma.

Acoustic neuroma is beginen slow-growing tumour that originates in the canal connecting the brain to the inner ear. It is understood that an acoustic neuroma begins in the cells that line one of the cranial nerves. Acoustic neuroma is responsible for sending information about hearing and balance to the brain .The auditory nerve connects the inner ear to the brain.. Acoustic neuromas usually grow slowly and can take years to develop. Some acoustic neuromas remain so small that they do not cause any symptoms. As the acoustic neuroma grows it can interfere with the functioning of the vestibular nerve and can cause vertigo and balance difficulties.

Acoustic neuroma may be found in people with the disease neurofibromatosis. Acoustic neuroma occurs in two forms: a sporadic form and a form associated with an inherited syndrome called neurofibromatosis type II (NF2). A small percentage of individuals have neurofibromatosis type 2 (NF-2) which is a hereditary condition. It is bilateral acoustic neuromas are the hallmark and typically present before the age of 21 . An acoustic neuroma develops when the Schwann cells that surround the auditory nerve grow too rapidly. The usual tumor in the adult presents as a solitary tumor, originating in the nerve. It usually arises from the vestibular portion of the 8th nerve, just within the internal auditory canal. As the tumor grows along the vestibular nerve it may cause this nerve to quit working, resulting in imbalance or even vertigo the sensation that the room is spinning. As it grows

Causes of Acoustic Neuroma

Followimg causes are includes below:

• Unilateral hearing loss.
• shearing loss and
• tinnitus

Symptoms of Acoustic Neuroma

Acoustic neuromas generally grow slowly, so the symptoms develop gradually and are easy to miss or misinterpret. The early symptoms of an acoustic neuroma may include one or more of the following:

• Loss of balance or clumsiness
• Facial weakness, pain, numbness or tingling
• A feeling of something clogging the ear
• Headache
• Pain in the face
• Facial numbness
• Visual disturbances, such as double vision
• Double vision
• vertigo (an abnormal sensation of movement)

Acoustic neuromas can also affect the functioning of the vestibular branch of the vestibulocochlear nerve and van cause vertigo and dysequilibrium. As the tumor grows larger it can press on the surrounding cranial nerves. Compression of the fifth cranial nerve can result in facial pain and or numbness.

Treatment of Acoustic neuroma by surgery

The three treatment options for acoustic neuroma are surgery, radiation, and observation. The physician and patient should discuss the pros and cons of the different options prior to making a decision about treatment. The patient's, physical health, age, symptoms, tumor size, and tumor location should be considered.

There are two methods available for the treatment - surgical removal and radiotherapy. These two methods and other known methods are described below, please have a look:

• In many cases the tumour can be completely removed and no further treatment is necessary. Before you have surgery your doctor will discuss the possible risks associated with this type of operation.
• Radiation therapy is done in a variety of ways, but mainly by two methods: gamma knife radiosurgery or fractionated stereotactic radiotherapy. In the gamma knife approach, 201 beams of gamma radiation are focused on the tumor in a single session.
• About half of all acoustic neuromas are treated by surgery, about a quarter with radiation (this is increasing), and about a quarter are watched.
• No matter what method of treatment is used, hearing preservation is very unlikely.
• For some people who have small, slow-growing tumors, it may be reasonable to delay treatment and monitor the growth of the tumor.
• Without treatment, important nerves (including the hearing, facial and balance nerves) can be affected and the growing tumour may eventually encroach on the brain.
• Large tumors may also compress nerves important for facial movement and sensation. These tumors can typically be safely removed, but the surgery often results in paralysis of some facial muscles.
• Stereotactic radiosurgery is a viable option for those who seek successful treatment without invasive surgery.

Treatment may include:

• Surgical removal of the Acoustic neuroma tumor- In most instances surgical removal of the tumor is the preferred option because it prevents potentially fatal complications of tumor growth (although this would be very unusual). 
• Gamma knife radiosurgery to slow or stop the growth of the tumor - Although it avoids surgery with its attendant risks, this option is usually recommended only for high-risk surgical cases because of the possibilities of late radiation complications, hydrocephalus in about 10 percent of patients, and the need for ongoing MRI monitoring of the results of the procedure

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