Understanding Your Treatment Options

Treatment for acoustic neuroma is personalized, depending on tumour size, location, growth, overall health, and patient preferences. Making an informed decision often involves consulting a multi-disciplinary care team.

Multi-disciplinary Care

Your care team may include:

• Skull-Base Neurosurgeon: Leads surgical planning and removal for tumours near the brainstem or cranial nerves
• ENT – Head and Neck Surgeon: Collaborates on surgery when tumours involve the ear or internal auditory canal and evaluates ear health
• Otologist / Neurotologist: Focuses on ear and nerve function; helps with surgical planning and post-treatment rehabilitation
• Radiation Oncologist: Provides non-surgical radiation options and monitors tumour response
• Audiologist / Vestibular Specialist: Measures hearing and balance function before and after treatment and assists with rehabilitation
• Neurologist / Neuropsychologist: Assesses facial nerve and cognitive function
• Radiologist: Performs imaging to establish baseline tumour size and location

Key Points:

Consulting multiple specialists ensures a full understanding of risks, benefits, and outcomes.

Second opinions are encouraged if time allows.

Shared decision-making helps align your treatment plan with both medical needs and personal priorities.

Choosing a Treatment

Each treatment option has benefits and limitations. Decisions are guided by:

• Symptoms and quality of hearing
• Age and overall health
• Tumour size and growth rate
• Tumour location and possible involvement with cranial nerves and other brain structures
• Lifestyle considerations
• Your personal preferences

Your healthcare team will work with you to create a plan best suited to your situation.

Treatment Options

There are three primary treatment options for acoustic neuroma: 

1. Watch and Wait (Observation)

What it involves:

Regular monitoring with MRI scans and hearing/balance tests, typically every 6–12 months.

Why it’s used:

• Many acoustic neuromas grow very slowly—or not at all
• Observation can help avoid unnecessary treatment and its potential risks
• Often recommended for small tumours (<1.5 cm) or when hearing is not severely affected

Considerations:

• Symptoms may progress slowly, and some patients remain stable for years
• Tracking and reporting new or worsening symptoms is important
• Immediate treatment is usually reserved for noticeable tumour growth or increasing symptoms
• If the tumour grows or becomes life-threatening, radiation or surgery may be necessary

2. Radiation Therapy

What it involves:

• Targeted radiation (stereotactic radiosurgery) to stop tumour growth or shrink the tumour
• Typically used for tumours under 2.5–3 cm
• Effects may take weeks, months, or years to become noticeable

Common techniques:

Gamma Knife (GK)

• Precise radiation without an incision
• Headframe keeps the head still during a single outpatient session
• Minimal downtime; patients can often resume daily activities immediately

CyberKnife (Linear Accelerator, a.k.a. LINAC)

• Uses a custom mesh mask instead of a headframe
• Multiple outpatient sessions may be required
• Minimal downtime; daily activities usually resume quickly

Why it’s used:

• Non-invasive alternative to surgery
• Aims to preserve facial nerve function and, ideally, hearing
• Often chosen for small- to medium-sized tumours or for patients who are not surgical candidates

Considerations:

• Hearing preservation is possible but not guaranteed
• Side effects may include fatigue, swelling, or delayed facial nerve changes
• Regular follow-up with MRI scans and hearing tests is required

3. Surgery

What it involves:

• Surgical removal of the tumour, usually via one of several approaches depending on tumour size and location
• Can involve complete removal (resection) or partial reduction (de-bulking)

Goals:

• Remove the tumour while preserving facial nerve function and, when possible, hearing

Surgical approaches:

Translabyrinthine

• Used when hearing cannot be preserved
• ENT and neurosurgeon collaborate
• Provides the best chance of preserving facial nerve function
• Surgery may exceed 5 hours

Retrosigmoid/Sub-Occipital

• Common when hearing can still be preserved
• Often used for small-to-medium tumours or tumours near the brainstem
• Allows for hearing preservation in select cases

Middle Fossa

• Used for small tumours confined to the internal auditory canal
• Aims to preserve hearing
• Radiation may be considered as a less invasive option for very small tumours

Considerations:

• Recovery can vary from weeks to months
• Risks include hearing loss, balance issues, facial weakness, cerebrospinal fluid leakage, stroke, infection, or persistent headaches
• Surgery is usually recommended for larger or rapidly growing tumours, or when symptoms significantly affect quality of life
• Post-surgery, periodic MRI scans monitor for tumour regrowth; if this occurs, radiation may be considered instead of repeat surgery