Optimal treatment of Acoustic Neuroma requires a dedicated team approach utilizing innovative techniques to treat the tumor. Multiple specialties including neurosurgery, neurotology, neuroradiology, radiation oncology, neurophthalmology, neuroanesthesiology, and physical therapy, among others, are involved in treatment of this complex tumor. With many years of experience in treating and innovating, the physicians and providers at the The Center for Acoustic Neuroma have joined together to provide state of the art diagnosis and treatment options for patients with Acoustic Neuroma.
Our physicians and providers are experienced specialists in the treatment of Acoustic Neuroma. Our surgeons have been treating Acoustic Neuroma for decades and have been instrumental in developing innovative ways to successfully manage patients with Acoustic Neuroma. Most importantly, our center is collaborative with physicians from all specialties involved in the care of this tumor. Our doctors are all fellowship trained in the care of skull base tumors and have more than 50 years of combined experience in skull base surgery for Acoustic Neuroma.
We are experienced and comfortable with all surgical approaches and tailor each surgery to the needs of the individual patient and tumor. We offer all three general approaches to patients with Acoustic Neuroma, or any combination of these three. The three general approaches are the translabyrinthine approach, middle cranial fossa approach, and the retrosigmoid posterior fossa approach.
We expect complete total tumor removal during surgery. There are cases, though, that we may leave a very thin shell of tumor on the facial nerve or brainstem rather than risk damage to the nerve itself or the very important brainstem area. In these situations, only a tiny amount of tumor remains and any remaining tumor left to preserve facial nerve function typically does not grow.
If a thin shell of tumor is left on the nerve or brainstem, we monitor this area with annual MRI scans. In rare cases, we may need to radiate the small residual tumor if we see any signs of growth and generally these are responsive to radiation therapy.
Yes, we perform all our skull base surgeries as a multi-specialty team that includes fellowship-trained skull base neurosurgeons and neurotologists. We strongly believe that a team approach to the treatment of Acoustic Neuroma is advantageous and provides a better outcome for our patients. In addition, we have a full team of other physicians including radiation oncologists and other providers to care for your tumor.
One of the most critical parts of any surgical procedure is preserving facial nerve function. It is of the highest priority for our physicians to preserve the facial nerve function. If removing the tumor completely places undo risk to the facial nerve, our surgeons may leave a thin shell of tumor on the nerve itself rather than sacrifice facial function. In addition, we perform state of the art facial nerve monitoring and continuous electrophysiological testing to improve outcomes. Our facial nerve preservation rate is one of the best in the country because of our experience with the nerve as well as precautions taken to preserve its’ function.
Hearing preservation following surgery will depend on the size and location of the tumor on the hearing nerve. If a patient has good hearing prior to surgery, we will attempt to remove the tumor using one of our hearing preservation approaches. When hearing preservation is possible, we monitor the hearing nerve during the entirety of the surgery to achieve best hearing outcomes possible. If the tumor is quite large, or if the hearing has already been negatively impacted by the tumor, preservation of hearing may not be possible.
With years of refining and improving our surgical techniques, our outcomes are excellent. We have developed strategies to minimize the risk associated with surgical removal of Acoustic Neuroma. Our rate of cerebrospinal fluid leak is less than 2%, our stroke rate is less than 0.3%. With an innovative approach to retrosigmoid posterior fossa resection of Acoustic Neuroma, our incidence of headaches postoperatively is less than 2%. These favorable outcomes are a direct result of our collaborative approach to tumor resection as well as our experience in caring for patients with these tumors.
When observing a tumor, we typically perform the first MRI at six to 12 months after the first MRI. We follow this appointment with regular MRIs at one-to two-year intervals, depending on the tumors growth rate and our plan of action.
Following surgery, we obtain an MRI at 3 months after surgical removal of the tumor. This is a baseline scan that is used moving forward. We typically perform the next scan at one year after the baseline post operative scan. If your tumor was removed completely, your next scans are usually at three and five years. If some tumor was left on the facial nerve to preserve its integrity, we may recommend more frequent MRI scans, possibly every year, to monitor the area for any changes.
We perform our surgeries at either Baylor University Medical Center in Dallas or at Medical City Dallas Hospital. Both facilities are large, state of the art hospitals with advanced Neurosurgical/Neurovascular Intensive Care Units (NVICU). Immediately after surgery, you will be transferred to the NVICU where there is a dedicated intensive care team of physicians and nurses monitoring our patients 24/7. All nurses and staff are specially trained to care for neurosurgery patients.
Typically, after recovering for 24-48 hours in the NVICU, our patients will be transferred to the neurosurgical floor where they will continue recovery from their surgery. On the floor, specialized neurologic rehabilitation will continue and you will be walking around the floor and gaining strength and balance. Once you are walking safely and have been cleared by our physical therapy team, you will be discharged home. Most of our patients are sent home 3-5 days after surgery. Our surgical team will monitor your progress daily and discharge decisions will be made by your surgeons as well as the other physicians and caregiving team.
Once you are discharged home, we will want you to be active at home and will also have balance exercises that we would like for you to do. We will want you to be active to help your balance system recover from the tumor and the surgery to remove the tumor. You will return to our offices two weeks after surgery to remove the sutures and check the wound. Once this is completed, you will be scheduled an appointment for an MRI three months after surgery as well as another follow up appointment to review the MRI and check on your progress.
We recommend that patients plan on taking one month off work after surgery to remove Acoustic Neuroma. Often, patients return to work sooner than this. Some patients may need more time off work than a month. Generally speaking, a good estimate for time off work is one month after surgery.