Vestibular Schwannoma: What Are Your Options?

Vestibular schwannoma, also known as acoustic neuroma, is a non-cancerous tumor that develops on the vestibular nerve, which connects the inner ear to the brain. While these tumors are typically slow-growing, they can cause various symptoms, including hearing loss, balance issues, and tinnitus. This article explores the various treatment options available for vestibular schwannoma, from non-surgical interventions to surgical procedures.

In some cases, watchful waiting or observation may be recommended. This approach is often chosen when the tumor is small, slow-growing, and not causing significant symptoms. During the waiting period, patients undergo regular medical check-ups and MRI imaging scans to monitor the tumor’s size and progression. The primary goal is to avoid unnecessary treatment, as some vestibular schwannomas may remain stable or shrink over time, posing no immediate threat to the patient’s health.

• When the vestibular schwannoma is small and does not cause noticeable symptoms.
• When the tumor’s growth rate is slow and poses a low risk of immediate complications.
• When the patient’s overall health or age may not support aggressive treatments.
• When preserving hearing or facial nerve function is a primary concern.
• When the tumor’s characteristics suggest, it may remain stable or even shrink over time.

• Avoids potential treatment-related side effects.
• Allows for monitoring of tumor progression and growth.
• Minimizes unnecessary interventions for slow-growing tumors.
• Potential for tumor stability or shrinkage over time.

Stereotactic radiosurgery is a non-invasive treatment option for vestibular schwannoma, especially when surgery is not suitable or preferred. Despite its name, it does not involve traditional surgical incisions. Instead, it delivers precisely targeted radiation to the tumor, gradually shrinking and controlling its growth over time. This technique minimizes damage to surrounding healthy tissue and can be a valuable alternative for patients who desire a less invasive approach or have medical conditions that preclude surgery.

• When the vestibular schwannoma is small to medium-sized.
• When surgery poses a higher risk due to the tumor’s location or the patient’s health.
• When preserving hearing or facial nerve function is a priority.
• When patients prefer a non-invasive, outpatient treatment option.
• When regular monitoring and gradual tumor control are acceptable.
• When a multidisciplinary medical team deems it a suitable choice.

• Non-invasive treatment option, avoiding surgical incisions.
• Minimizes damage to surrounding healthy tissue.
• Suitable for patients with small to medium-sized tumors.
• Preserves hearing and facial nerve function whenever possible.
• Outpatient procedure with limited recovery time.
• Effective tumor control and potential reduction in size over time.

For larger or more symptomatic vestibular schwannomas, surgical removal is recommended. Acoustic neuroma surgery aims to completely remove the tumor while preserving hearing and facial nerve function whenever possible. There are different surgical approaches, including microsurgery and techniques like suboccipital or retrosigmoid craniotomy, translabyrinthine craniotomy, or middle fossa craniotomy, each chosen based on the tumor’s size, location, and the patient’s overall health. The surgical removal of the tumor can also improve issues related to balance, facial numbness, and other symptoms.

• When the vestibular schwannoma is large and causing significant symptoms.
• When the tumor’s growth threatens vital structures, such as the brainstem or nearby nerves.
• When the patient’s hearing loss is severe and not amenable to other treatments.
• When there is an urgent need to alleviate symptoms or prevent further complications.
• When the patient and medical team decide surgery is the most appropriate course of action.

• Complete removal of the vestibular schwannoma.
• Potential preservation or improvement of hearing and facial nerve function.
• Relief from symptoms such as hearing loss, imbalance, and tinnitus.
• Prevention of further tumor growth and associated complications.
• An option for patients with large or rapidly growing tumors.
• Opportunity for a definitive treatment.

Dr. Lekovic is a board-certified neurosurgeon renowned for his expertise in skull base and cerebrovascular surgery. If you or a loved one is dealing with vestibular schwannoma, schedule a consultation with Dr. Lekovic and his experienced team to discuss your individual case, explore the available treatment options, and reclaim optimal health. Vestibular schwannoma can potentially worsen over time and cause severe complications, so time is of the essence.