What is an acoustic neurinoma?

The acoustic neurinoma is also known as vestibular schwannoma. It is a benign tumour of the balance nerve that grows slowly. 

The most typical symptom of the acoustic neurinoma is impaired hearing that develops gradually over several years. Ringing in the ear or tinnitus may also occur remittently over the years. In about ten percent of patients, the ear becomes deaf suddenly.

The tumour might cause spells of dizziness, but most patients suffer from difficulties with balance that usually come about with sudden movements or in the dark. Some patients may suffer from headaches or localised pains.

A diagnosis of the acoustic neurinoma is best confirmed by magnetic resonance imaging. In Finland, about 70 patients are operated annually for this disease. 

How is the acoustic neurinoma treated?

Once the acoustic neurinoma has been diagnosed, treatment based on symptoms and their consequent problems are carefully considered, because there is always the risk of deafness as a result of surgical treatment of the tumour.

In many cases, it is possible to rescue hearing with surgery - more succesfully the smaller the tumour and the better the hearing before treatment. Hearing can be saved in about 40% of cases if the hearing is good before treatment. Impaired hearing cannot be improved with treatment.

If the patient is under 60 years of age, the tumour small and the hearing still good, then saving the hearing with early surgery can be considered. If the patient is over 60 years and the tumour small, then it should be established that the tumour is actually growing before considering surgical care.

If it has been decided to operate, then the objective is to remove the tumour completely. Should the tumour nonetheless be tightly attached to the facial nerve, it may be more sensible to leave a small portion of the tumour in place. Paralysis of the facial nerve often occurs after surgery, but nowadays paralysis is very seldom permanent. For some patients, headaches may be a long-term problem.

As an alternative to surgery, stereotactic radiation treatment may be applied. In Finland, radiation treatment has been kept as a secondary form of treatment and has been used only in cases where surgery is too risky because of the patient suffering from additional diseases. This is due to the fact that we still do not know what will happen to the tumour over an extended periot of time.