Invisible Acoustic Neuroma Surgery Removes Tumors With No Visible ...

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MedBlog

Brain; ENT

Invisible acoustic neuroma surgery removes tumors with no visible scarring

August 22, 2019

Brain; ENT

Brandon Isaacson, M.D. Otolaryngology

A healthcare professional uses a specialized microscope to examine a patient's ear. — Dr. Brandon Isaacson examines Lloyd Griffith, who had a pioneering procedure at UT Southwestern to remove an acoustic neuroma and restore his hearing.

Patients sometimes consider hearing loss to be a natural part of aging. However, in some patients, it can indicate the presence of an acoustic neuroma – a rare, skull-base tumor that originates from Schwann cells that insulate the hearing and balance nerves.

UT Southwestern is the only center in Texas – and one of just two in the U.S. – to offer invisible acoustic neuroma surgery (transpromontorial approach), an innovative, minimally invasive procedure to remove these non-cancerous tumors through a tiny incision in the ear canal. Aptly named, this procedure eliminates visible scarring.

Acoustic neuroma is a rare condition that can affect men and women of all ethnicities, typically those 40 and older. As a primary referral center for acoustic neuroma, UT Southwestern has experts who see multiple new cases weekly and provide ongoing care for those who don’t require immediate treatment.

Minimally invasive ear surgery removes tumors

Lloyd Griffith relished hearing the rumble of cars until the day a tumor in his ear caused his hearing to go from garbled to silent. Today his hearing is much improved, thanks to a pioneering minimally invasive procedure at UT Southwestern – one of the highest-volume acoustic neuroma programs in Texas.

Treatment options for acoustic neuroma

Patients with small tumors and minimal symptoms are typically observed. Advances in MRI technology allow physicians to monitor the growth of acoustic neuromas, which in many cases can allow patients to avoid or delay treatment. Patients who opt for active surveillance typically receive annual MRIs to check for tumor progression.

Treatment is recommended for patients with growing tumors, patients whose symptoms significantly affect quality of life, or, in rare cases, patients whose tumors are life-threatening due to their size.

Candidates for invisible acoustic neuroma surgery are patients with a small tumor that is symptomatic or growing, and who have poor hearing in the affected ear. In this procedure, we make a small incision in the ear canal and remove a small amount of bone to extract the tumor; the approach leaves no visible scarring behind the ear or in the scalp.

A detailed cross-section diagram of the ear showing the cochlear nerve, vestibular nerve, facial nerve, and acoustic neuroma.

Patients with symptomatic or growing tumors have three other surgical options, depending on their hearing status and the size and location of the tumor. Each of these procedures require some bone removal to provide surgical access:

Middle fossa approach: This commonly performed technique requires a 2-inch, in-front of-the-ear incision that runs up to the scalp.
Retrosigmoid approach: Also known as suboccipital craniotomy, this is the classic technique to remove acoustic neuromas. The surgery requires a 2- to 3-inch incision behind ear that extends into the upper neck.
Translabyrinthine approach: This commonly performed technique requires a 3-inch incision above and behind the ear.

Additionally, we offer Gamma Knife radiosurgery for patients who are not candidates for, or who do not want surgery. As with any procedure, there are risks involved with acoustic neuroma treatment. Some patients might experience facial paralysis, spinal fluid leak, or, rarely, a brain stem injury, depending on the tumor size and location, as well as the type of procedure. UT Southwestern can provide rehabilitation and supplemental care should a patient encounter any adverse effects.

Surgery or radiation for acoustic neuroma are effective management options, but neither can restore natural hearing. However, sometimes we can preserve residual hearing in the affected ear if the tumor is small and in an ideal location. Many patients opt for hearing aids to help with hearing after surgery, depending on their level of hearing loss.

Why doctors refer patients to UT Southwestern

The UT Southwestern Comprehensive Skull Base Program is staffed by a multidisciplinary team of neurotologists, neurosurgeons, neuroradiologists, radiation oncologists, rhinologists, anesthesiologists, physical therapists, and specialized nurses. The team holds a monthly tumor conference to discuss all skull-base tumor cases, including acoustic neuromas. By pooling their expertise, our team members provide comprehensive, unified treatment plans to equip patients with the necessary information to make informed decisions about their care.

A close-up image of an MRI scan, with a hand pointing at a specific area in the brain.

Acoustic neuroma team

UT Southwestern's comprehensive team approach to treating acoustic neuromas has made it one of the most trusted centers in the country for treating skull base tumors.

Learn more

Our acoustic neuroma team members include:

Neurotology: J. Walter Kutz, M.D.; Jacob Hunter, M.D.; Brandon Isaacson, MD
Neurosurgery: Sam Barnett, M.D.; Bruce Mickey, M.D.
Neuro-oncology: Laura Klesse, M.D., Ph.D.
Neuroradiology: Carlos Perez, M.D.; Marco Da Cunha Pinho, M.D.; Dianne Mendelsohn, M.D.; William Moore, M.D.
Radiation Oncology: Zabi Wardak, M.D.; Lucien Nedzi, M.D.; Robert Timmerman, M.D.
Vestibular and Facial Rehab: Egle Bauzaite, D.P.T.

As a primary referral center for skull-base tumors, UT Southwestern uses the most advanced tools to care for patients with moderate to complex cases of acoustic neuroma, including neurofibromatosis 2, in which patients have tumors in both ears, as well as elsewhere in the head, and spine. With UT Southwestern’s team of experts and resources, these patients can access advanced procedures and devices, such as the auditory brainstem implant, which potentially can assist with hearing if a cochlear implant is not an option.

If you suspect that you or a loved one might have an acoustic neuroma, call 214-645-8300 or request an appointment online.

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