The treatment you have will depend on the size of the tumour, how the symptoms are affecting you and your general health. The main treatments are radiotherapy or surgery.
A team of specialists will plan your treatment. This will usually include a surgeon who specialises in operating on conditions of the nervous system (neurosurgeon), and a specialist ear, nose and throat (ENT) surgeon (called a neuro-otologist), a cancer doctor (oncologist) and a specialist nurse.
They will explain the aims of your treatment, the benefits and disadvantages, and possible risks. Deciding on the treatment that is right for you is a decision you make in partnership with your doctor. Make sure you have enough information and time to help you make any treatment decisions.
If the tumour is small and causing only mild symptoms, you may not need treatment straightaway. Acoustic neuromas tend to be very slow-growing and it may be a long time before you need treatment. You will have regular scans to make sure the tumour is not growing. This can be a good option when the effects of surgery or radiosurgery outweigh the risk of an acoustic neuroma affecting your health.
Radiotherapy treatment uses high energy rays to destroy the tumour cells. Acoustic neuromas are treated with a targeted radiotherapy called stereotactic radiotherapy. You have this as a course of treatment over a number of daily sessions from Monday to Friday.
Several beams of radiation are given from different angles, overlapping at the tumour. This gives a high dose to the tumour and very low doses to surrounding healthy tissue so helps to reduce side effects.
These treatments reduce the risk of permanent effects such as hearing loss and facial nerve damage that you get with surgery. But some people may still have some hearing loss and occasionally some damage to the facial nerve.
You have this type of stereotactic radiotherapy as a single session of high-dose focused treatment. This is often the treatment for smaller tumours, as there are likely to be fewer side effects than with surgery. It is sometimes called gamma knife treatment, named after the machine that’s used. It doesn’t involve any surgery.
Surgery is usually only used to remove larger tumours as an operation is likely to have more side effects than stereotactic radiotherapy or radiosurgery.
Your surgeon will explain what it involves and what the possible complications and risks are. The operation is done through the skull. Sometimes they leave a tiny part of the tumour to try to avoid damaging the facial nerve. Any tumour that is left behind can be treated with stereotactic radiosurgery.
Surgery will usually cause hearing loss in the affected ear. Your surgeon may talk to you about being fitted with a special type of hearing aid, which diverts sounds from the affected ear to your other ear. You will usually see a hearing specialist for expert help and advice.
Doctors may delay surgery, if possible, in people who have large tumours of both acoustic nerves because of the risk of total hearing loss. You will have MRI scans to monitor the tumours. Occasionally, they operate on one side first. If you can hear with this ear after surgery, you then have the other side operated on. If hearing is lost during the first operation it may be possible to delay surgery on the second tumour, or to use radiotherapy.
Sometimes surgery may damage the facial nerve. This can cause numbness or drooping (palsy) of one side of the face, which is sometimes permanent. It can affect actions like chewing and blinking. A physiotherapist will show you exercises and massage that you can do to help improve this. Some people also get a dry eye. Eye drops will help with this. If necessary, your doctor can refer you to an eye specialist. The British Acoustic Neuroma Association has more information.