Acoustic Neuroma Surgery

Acoustic neuroma is a noncancerous, slow-growing tumour usually seen in middle-aged people. It develops on the main nerve leading from the inner ear to the brain, which controls hearing and balance. As the tumour grows and compresses on the brain stem and surrounding nerves it affects related functions and produces symptoms such as ringing in the ears, dizziness, facial weakness, persistent headache and problems with vision. Acoustic neuromas are usually treated by surgery and/or radiation, followed by rehabilitation. Surgery is recommended for the treatment of large acoustic neuromas and involves a craniotomy, the removal of a portion of the skull to access and remove the tumour.

The aim of surgery is to remove as much of the tumour as possible while avoiding damage to the facial nerve, brainstem and hearing. It is performed above or behind the ear to preserve facial nerve function and hearing as much as possible. It may be performed through the ear if hearing is already affected.

Craniotomy is performed under general anaesthesia. The region of the skull over the tumour is shaved and prepped with antiseptic. An incision is made over the tumour, and skin and muscles are separated from the bone and folded back. With the help of a drill and a special saw, your surgeon cuts open the skull bone to form a bone flap. The dura, protective covering of the brain, is then cut and removed and stored for later. Facial nerve and brainstem functions are assessed throughout the procedure with the help of a probe. All or part of the tumour is removed. If necessary, a part of it may be left behind to prevent damage to important structures. The dura is then stitched back in place, the bone flap is placed back and secured with plates and screws, and the muscles and skin are sutured. A soft dressing is placed over the incision and a drain may be placed to remove fluid or blood from the surgical site. After surgery, your vitals and neurological response will be closely monitored.

As with all surgical procedures, craniotomy for acoustic neuroma may be associated with persisting symptoms, cerebrospinal fluid leak, facial paralysis, stroke, meningitis and tumour recurrence.