Acoustic Neuroma Treatment: Balancing Surgery and Radiosurgery for Optimal Outcomes

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• What is Acoustic Neuroma?
• Treatment Challenges and Risks
• Surgery vs. Radiosurgery for Acoustic Neuroma
• Facial Nerve Preservation in Acoustic Neuroma Surgery
• Clinical Trial Insights on Acoustic Neuroma Care
• Importance of a Medical Second Opinion
• Full Transcript

What is Acoustic Neuroma?

Acoustic neuroma, also known as vestibular schwannoma, is a benign brain tumor. Dr. Philip Theodosopoulos, MD, explains that these tumors arise from the nerves of the balance system. They are slow-growing tumors that develop near the brain stem and cranial nerves. Despite the name "acoustic neuroma," the tumor does not originate from the acoustic nerve itself. The most common initial symptom is hearing loss or dysfunction.

Dr. Anton Titov, MD, notes that these tumors often grow over many years. They are frequently asymptomatic aside from hearing-related issues. Their location makes them particularly challenging for neurosurgeons to treat without affecting critical neurological functions.

Treatment Challenges and Risks

Acoustic neuroma treatment presents unique challenges in neurosurgery. Dr. Philip Theodosopoulos, MD, describes a fundamental paradigm: "I can only hurt you by treating you." This reflects the delicate balance required when operating near the brain stem and cranial nerves. The facial nerve, which controls smiling and eye closure, is particularly vulnerable during treatment.

Dr. Philip Theodosopoulos, MD, emphasizes that these tumors are not malignant and won't typically cause death if left untreated. However, they can significantly impact quality of life as they grow. The primary treatment risk involves damaging adjacent neurological structures while attempting to remove or control the tumor.

Surgery vs. Radiosurgery for Acoustic Neuroma

Treatment options for acoustic neuroma include microsurgery and gamma knife radiosurgery. Dr. Philip Theodosopoulos, MD, explains that radiosurgery uses focused radiation without surgical incisions. This approach is often suitable for smaller tumors. The development of radiosurgery has pushed neurosurgeons to improve their surgical techniques and outcomes.

Dr. Anton Titov, MD, discusses how the field has evolved to incorporate both modalities. Dr. Theodosopoulos believes the same physician should be able to offer both surgery and radiation options. This comprehensive approach ensures patients receive the most appropriate treatment for their specific case.

Facial Nerve Preservation in Acoustic Neuroma Surgery

Modern acoustic neuroma treatment prioritizes facial nerve preservation over complete tumor removal. Dr. Philip Theodosopoulos, MD, states that surgeons may intentionally leave some tumor behind to protect nerve function. This represents a significant shift in surgical philosophy. The remaining tumor then requires careful management decisions.

Dr. Philip Theodosopoulos, MD, explains that leftover tumor tissue can potentially regrow to its original size. This creates complex decisions about whether to observe, use radiation, or consider additional surgery. The treatment approach must be tailored to each patient's unique situation and tumor characteristics.

Clinical Trial Insights on Acoustic Neuroma Care

A multi-center clinical trial is providing valuable insights into acoustic neuroma treatment outcomes. Dr. Philip Theodosopoulos, MD, serves as a Principal Investigator in this ongoing research. The study has been collecting data for five to six years across specialized treatment centers. Results demonstrate that even at expert centers, treatment outcomes are not perfect.

Dr. Anton Titov, MD, highlights how this research pushes surgeons toward technical excellence. The trial aims to combine data from multiple institutions to determine optimal treatment approaches. This collaborative effort helps identify best practices for both surgical and radiation treatments.

Importance of a Medical Second Opinion

Seeking a medical second opinion is crucial for acoustic neuroma patients. Dr. Philip Theodosopoulos, MD, emphasizes that treatment decisions should prioritize what's best for the patient. This is more important than what's most convenient or lucrative for the physician. A second opinion confirms the diagnosis and helps select the most appropriate treatment approach.

Dr. Anton Titov, MD, notes that acoustic neuroma treatment requires highly specialized expertise. Patients should seek opinions from neurosurgeons who regularly treat these complex tumors. This ensures access to the latest techniques and treatment philosophies that prioritize quality of life outcomes.

Full Transcript

Acoustic neuroma: surgery or gamma knife? Medical second opinion helps to select the best method of treatment—best for a patient, not most convenient for a neurosurgeon or most lucrative for a radiotherapy doctor. Acoustic neuroma is defined by the paradigm, "I can only hurt you by treating you." Complete removal of acoustic neuroma risks damage to adjacent cranial nerves and the brain stem. Balance is difficult to achieve in treatment of acoustic neuroma.

Dr. Anton Titov, MD: Acoustic neuroma treatment medical second opinion. Video interview with leading neurosurgeon who treats acoustic neuromas, Dr. Philip Theodosopoulos, MD. Leading skull base neurosurgeon shares his vision and experience in treatment of acoustic neuromas. Medical second opinion helps to find the best treatment options for each patient with acoustic neuroma.

Acoustic neuromas arise from the balance system nerves. Acoustic neuroma is an example of a tumor when a neurosurgeon can say, "I can only hurt you by treating you." Medical second opinion confirms that acoustic neuroma diagnosis is correct and complete. Medical second opinion also helps to choose the best treatment for acoustic neuroma.

Seek medical second opinion on large acoustic neuroma and be confident that you choose the best neurosurgeon.

Dr. Philip Theodosopoulos, MD: Acoustic neuroma is a big tumor located close to the brain stem. This tumor often grows slowly. Often hearing loss is the only symptom of acoustic neuroma. Open brain surgery or radiosurgery can treat these tumors.

Dr. Anton Titov, MD: Gamma knife can be good for smaller tumors. It is important to carefully select the method of treatment for acoustic neuromas. There are multi-center clinical studies on quality of treatment in acoustic neuromas. The clinical outcome of the patient is most important in therapy of acoustic neuroma.

Dr. Philip Theodosopoulos, MD: Radiosurgery is part of neurosurgery to treat acoustic neuroma and vestibular schwannoma. Treatment of acoustic neuromas can really challenge the neurosurgeon. Get medical second opinion to treat acoustic neuromas.

Dr. Anton Titov, MD: Let's turn to some specific problems that you frequently deal with in your clinical practice. You have done recently an extensive review of treatment of acoustic neuromas. Could you please describe vestibular schwannoma? What is acoustic neuroma? What are typical symptoms of acoustic neuromas? Please talk about advances in treatment of acoustic neuromas.

Dr. Philip Theodosopoulos, MD: Acoustic neuromas are a big part of my surgical practice. I have been in neurosurgical practice for almost 15 years after my fellowship. Acoustic neuromas are benign tumors that arise from the nerves. These cranial nerves have to do with the balance system. These nerves run along with the hearing nerves as well.

We call these tumors acoustic neuromas, but they are not really from the acoustic nerve. They are called so because patients with acoustic neuromas have hearing dysfunction. These tumors grow slowly over years, but they can cause a lot of problems because acoustic neuroma is attached to the brain stem and to the nerves. Acoustic neuroma is particularly attached to the facial nerve—the nerve that makes us smile and close eyes.

Dr. Anton Titov, MD: As such, acoustic neuroma has been a very difficult tumor to treat. Acoustic neuroma is an example of a tumor in neurosurgery that can be described as this: "I can only hurt you by treating you."

Dr. Philip Theodosopoulos, MD: It is a big tumor right next to the brain stem. Acoustic neuroma often grows slowly. It is often asymptomatic other than some hearing loss. It is a very difficult tumor to get out without hurting anything.

Acoustic neuroma has been the one tumor that patients have referred very readily to the expert neurosurgeons. I have a lot of such referrals now. We have seen over the past couple of decades that doctors try to use radiosurgery to treat these tumors. Radiosurgery uses focused radiation without incisions. Radiosurgery really challenged neurosurgeons to make acoustic neuroma operations better and safer. We have to make patients less sick after surgery. We have had a completely different paradigm.

We have just had a research article published on treating big acoustic neuromas.

Dr. Anton Titov, MD: Treatment is focused on facial nerve preservation. It means that we don’t make paramount a complete resection of tumor. We focus on preserving the facial nerve function, even if that means leaving some tumor behind. Sometimes you leave some acoustic neuroma tumor behind to preserve facial nerve. Then what do you do with the tumor you left behind?

Dr. Philip Theodosopoulos, MD: Because the remaining acoustic neuroma can become a big problem if you let it grow. Brain tumor grows to the same size over time. Sometimes tumor grows to the same size. Then certainly we have not helped the patient because now they need more treatment. You might have used radiation first or later, or you have to decide to just observe the patient with acoustic neuroma.

Acoustic neuroma therapy is a whole new field. We have a multi-center clinical trial that is still going on. I am one of the Principal Investigators in that clinical trial. We are reporting also at the Congress of Neurosurgeons on the results. We have obtained these results over five or six years. We have been running our acoustic neuroma clinical trial.

Acoustic neuromas are an example of a condition in neurosurgery that is so specialized in its treatment because acoustic neuromas are mostly treated at very specific centers. Our clinical trial shows that despite treatment at highly specialized centers, acoustic neuroma treatment results are not perfect. We still really don't know the optimal answer on the best method to treat acoustic neuromas.

To some degree, it is because we all have quote-unquote "smaller studies." We thought it would be great to have a combination of clinical trials where a lot of data can come in. Multi-center analysis of acoustic neuroma treatment pushes surgeons towards technical excellence because you have to be good to be able to do a larger study of acoustic neuromas resection.

When I say "be good," I mean that for every single acoustic neuroma case, you have to be better than you were the last time. You have to learn something from the previous surgery because acoustic neuroma operations are fraught with trouble. Acoustic neuroma treatment is one of those clear scenarios.

Dr. Anton Titov, MD: The result of treatment of the patient is the most important thing. Acoustic neuroma is not a malignant tumor that is going to kill you. Sure, with time, if we do nothing to it, acoustic neuroma will affect you. But acoustic neuroma treatment is something unique.

Dr. Philip Theodosopoulos, MD: You cannot afford hurting somebody by overzealous treatment. Treating acoustic neuromas has provided for neurosurgery field a full recalibration of what our surgery is all about. Acoustic neuroma has forced radiosurgery to become part of neurosurgery because you can offer radiation treatment for acoustic neuromas. Then you should be the same physician who can offer surgery for acoustic neuromas. Offering both neurosurgery and radiosurgery would be only fair to the patient.

Treatment of acoustic neuromas can really challenge the neurosurgeon. Neurosurgeon has to really understand what are the side effects of surgery. We can cause many complications to patients with vestibular schwannoma. Side effects happen no matter how we treat patients.

Dr. Anton Titov, MD: Neurosurgeon has to try to optimize the method of treatment for acoustic neuromas. Acoustic neuroma treatment: you must get a medical second opinion. Video interview with leading neurosurgeon who treats acoustic neuromas. Radiosurgery gamma knife, open brain surgery?