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Surgery for Acoustic Neuroma

You may reference the Anatomy of the Ear page for better understanding of the anatomy. 

Hearing Preservation Approaches:

Middle Fossa Approach 

The middle fossa approach is used for small tumors under 15 millimeters (3/5th of an inch) in patients who have useful hearing (see figure below). The approach involves an incision in front of the ear in the hairline and removal of the tumor from above. Hearing is preserved in 60-70% of patients.

The MRI of a patient with a small acoustic neuroma who was treated with a middle fossa approach by Dr. Djalilian. The image is a vertical slice of the head. The ears are on the two sides. The top of the head is at the top of the picture, and the neck is on the bottom of the picture. The arrows indicate the approach coming from above the ear to reach the tumor (the bright area at the end of the arrows). 

Hearing Preservation Approach:

Retrosigmoid Approach 

The retrosigmoid approach (sometimes called the suboccipital approach) is used in patients with hearing who have larger tumors than those treated with the middle fossa approach. The tumor is approached from behind the sigmoid sinus (a vein in the brain) and the inner ear is not disturbed. Hearing is preserved in about 50% of cases.

Hearing Sacrifice Approach:
 
Translabyrinthine Approach

This approach is primarily used in patients who have lost all useful hearing in the ear affected by the tumor. In this approach, the tumor is removed by approaching it through the inner ear. This approach is used when the patient's hearing is low or when the tumor is large.

MRI image of a patient with bilateral acoustic neuromas. The tumor on the left (the patient’s right) was treated with a translabyrinthine approach.

What does surgery involve?

The surgery is performed with a neurotologist/skull base surgeon and a neurosurgeon in tandem. The surgery is done under general anesthesia. The patients are typically admitted to the hospital for less than a week after surgery.

What are the complications of Sugery?

The most common complications of surgery include facial nerve weakness (temporary or permanent), loss of hearing, dizziness, and leakage of spinal fluid.

What to look for in your surgeon?

It is best that your surgery is done in by both a neurotologist-skull base surgeon (Ear, Nose & Throat subspecialized in ear and skull base surgery) and a neurosurgeon with skull base expertise. The team approach allows the patients to obtain the best care possible.  

New Innovations In the Treatment of Acoustic Neuroma

At UC Irvine, our skull base team uses the cutting edge in surgical technique and technology to reduce complications and to improve outcome. Some examples of technology available includes, intra-operative MRI, computer assisted navigation, ultrasonic bone removal, intra-operative multiple cranial nerve monitoring, among others.

For more information, you may visit the Acoustic Neuroma Association website: http://www.anausa.org/

To make an appointment please call 714-456-7017.

Click here to request an appointment via the web.
 

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