Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Acoustic Neuroma Removal

(Neurilemmoma; Vestibular Schwannoma)
Definition

An acoustic neuroma is a benign (noncancerous) tumor. It grows on the acoustic nerve, which runs from the brain to the ear. This type of tumor typically grows slowly. It may cause hearing loss, balance problems, facial numbness, and headaches.

There are three main treatment options for an acoustic neuroma:

This fact sheet focuses on microsurgical removal.

Reasons for Procedure
  • Concern that tumor size may become life-threatening
  • Tumor is causing hearing problems
  • Tumor is growing

A successful procedure results in complete removal of the tumor with minimal additional hearing loss.

Possible Complications

Side effects may be temporary or permanent. If you are planning to have this surgery, your doctor will review a list of possible complications, which may include:

  • Ringing in your ears ( tinnitus )
  • Bleeding
  • Difficulty with balance
  • Excessive eye dryness
  • Facial weakness and numbness on the side of the tumor
  • Headaches
  • Hearing loss
  • Infection
  • Leakage of cerebrospinal fluid (CSF)

Some factors that may increase the risk of complications include:

  • Older age
  • Size of the tumor
  • Smoking
What to Expect
Prior to Procedure

The following medicines may be given before the procedure:

  • Antibiotic—given by IV (into the vein) right before surgery
  • Steroids—usually started 48 hours before surgery

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:

  • Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
  • Aspirin or other anti-inflammatory drugs
Anesthesia

General anesthesia will be used. You will be asleep.

Description of the Procedure

The type of procedure will depend on your case. Factors such as hearing status and the size and location of the tumor will be considered. One of the following surgical methods will be selected:

Translabyrinthine

This is often used when you already have significant hearing loss. The mastoid bone (part of skull) and bone in the inner ear will be removed. This allows access to the ear canal and the tumor.

Retrosigmoid/Sub-occipital

An opening will be made in the skull behind the ear. This approach is used for large or small tumors. This process will make it easier to see and protect the nerves during surgery.

Middle Fossa

The tumor will be removed from the upper surface of the ear canal. This is used when there is a good chance that hearing may be preserved.

Immediately After Procedure

You will spend at least one night in the intensive care unit for care and observation.

How Long Will It Take?

The surgery takes about 6-12 hours. The exact length will depend on the size and location of the tumor.

How Much Will It Hurt?

Anesthesia will prevent pain during the procedure. You may notice pain after the procedure. Talk to your doctor about medicines to help manage the pain.

Average Hospital Stay

The usual length of stay is 4-7 days. Your stay may be longer if there are complications.

Post-procedure Care
At the Hospital

During recovery, you may have some of the following:

  • Dizziness
  • Emotional lows
  • Fatigue and sleepiness
  • Head discomfort
  • Headache
  • Nausea

Staff will help you manage these problems.

At Home

Once you return home, follow these guidelines for a safe recovery:

  • Also, ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Ask your doctor when you will be able to return to work.
  • Do not drive until your doctor allows it.
  • Keep the incision area clean and dry.
  • Take medicines as instructed.

Full recovery typically takes 4-6 weeks. MRI scans will be done regularly over the next several years. The scans will check to see if the tumor returns.

Call Your Doctor

After you leave the hospital, contact your doctor if you have:

  • Cough, shortness of breath, or chest pain
  • Nausea and/or vomiting that you cannot control with the medicines you were given after surgery or that persists for more than two days after discharge from the hospital
  • Pain that you cannot control with the medicines you have been given
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Runny nose
  • Signs of infection, including fever, chills, and neck stiffness
  • Stiff neck
  • Worsening headache

In case of an emergency, call for medical help right away.

Last reviewed: December 2010 by Elie Edmond Rebeiz, MD, FACS.

RESOURCES:
CANADIAN RESOURCES:
References:
  • Acoustic Neuroma Association website. Available at: http://anausa.org/ .
  • Bennett M, Haynes DS. Surgical approaches and complications in the removal of vestibular schwannomas. Otolaryngol Clin North Am . 2007;40(3):589-609.
  • International Radiosurgery Association website. Available at: http://www.irsa.org/ .
  • 6/2/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.