Acoustic neuroma surgery or gamma knife radiotherapy is an important decision. How to weigh treatment options for acoustic neuroma?
Acoustic neuroma surgery or gamma knife treatment depends on the size and location of the tumor. Radiosurgery for acoustic neuroma can be very effective in smaller tumors. Dr. Peng Roc Chen, MD. Expert cerebrovascular neurosurgeon explains. Gamma knife treatment for acoustic neuroma carries a small risk of tumor recurrence. This will require repeating of radiosurgery for acoustic neuroma. It may require open brain surgery. Video interview with top expert in endovascular neurosurgery. Medical second opinion confirms that acoustic neuroma diagnosis is correct and complete. Medical second opinion helps to choose the best treatment for acoustic neuroma. Get Medical second opinion on acoustic neuroma and be confident that your treatment is the best. There are side effects associated with open brain surgery. Dr. Peng Roc Chen, MD. Trigeminal neuralgia could be a symptom of acoustic neuroma. Acoustic neuroma surgery or gamma knife. 1234 Treatment of acoustic neuromas is a significant part of your surgical practice. Acoustic neuromas could be very complicated tumors to treat. Even though acoustic neuromas are slowly growing growing. They are often located in difficult areas of the brain. It is important to reduce the damage to the patient's brain when treating acoustic neuromas. Please tell us about the modern approach in treating acoustic neuromas? 1234 (Skull Base Neurosurgeon and Endovascular neurosurgeon, University of Texas). Best methods to treat acoustic neuromas are being debated over last 20 years. Acoustic neuromas are often located in difficult to reach and functionally important areas of the brain. Dr. Peng Roc Chen, MD. Acoustic neuromas frequently grow close to the facial nerve. But they grow slowly and are benign. There are two main methods to treat acoustic neuromas. Open brain neurosurgery has been used for many decades. Recent acoustic neuroma treatment is radiosurgery. Gamma knife is one example of radiosurgery technology to treat acoustic neuromas. The debate is going on for many years whether neurosurgery or radiosurgery is the best method to treat acoustic neuromas. It is similar to the recent developments in cerebrovascular surgery. Dr. Peng Roc Chen, MD. We can now combine two methods to treat acoustic neuromas together. We can determine best treatment method. Some acoustic neuromas are best treated by neurosurgery. Other patients are best treated by radiosurgery. We can also include wishes of the patient in decision of acoustic neuroma treatment method. 1234 First, we have to determine if we have to actively treat small acoustic neuroma. Some acoustic neuromas grow very slowly over many years. So we can monitor and observe the patients closely. Some patients will have hearing loss from acoustic neuromas. Other patients do not have any hearing loss. But it is reasonable to offer some patients careful observation and follow up. Their acoustic neuromas are small and grow very slowly. Some patients have very large tumors when patients first visit the doctor. The size of tumor could be more than 2.5 or 3 centimeters in diameter. Such patients may have significant brain stem compression They may have facial nerve paralysis. Some patients with large acoustic neuromas have problems swallowing. Some patients may have problems walking. In those patients with large acoustic neuromas the best method of treatment is clearly open neurosurgery. Open brain surgery can remove the tumor completely. Or surgeon can do a subtotal partial resection of tumor. Then we can use additional method of radiosurgery to treat large acoustic neuroma. So very small acoustic neuromas and very large acoustic neuromas are located at different ends of treatment spectrum. Dr. Peng Roc Chen, MD. We know very well what to do in these situations. We know how to treat very small or very large acoustic neuromas. However, medium size acoustic neuromas are in the middle of the spectrum - 2 to 2.5 centimeters in diameter. They usually cause some compression of brain stem. As neurosurgeons, we are biased towards a surgical treatment of acoustic neuromas. It is true especially if the patient’s overall health is good. In most cases these tumors can be completely removed (gross total resection). Surgical treatment of acoustic neuroma can decrease the probability of recurrence of tumor. Radiosurgery treatment of medium size acoustic neuromas is also very effective. However, there is a small risk of tumor recurrence several years after the radiation treatment. Patients with acoustic neuroma recurrence will need neurosurgery to treat their tumor. There is still some debate among doctors about the best treatment of recurrent acoustic neuromas. But I am in favor of neurosurgical treatment of acoustic neuromas. If the brain tumor grew to larger size. Sometimes the patient can tolerate the surgical operation. Dr. Peng Roc Chen, MD. I generally recommend to treat acoustic neuromas surgically. It is very important for best results in surgical treatment of acoustic neuromas to have a team-based approach to treating the patient. In the United States, neurosurgeons who specialize in skull base neurosurgery. They work as a team together with otolaryngology surgeons ("ENT surgeons"). These "ENT surgeons" who specialize in acoustic neuroma treatment are called "neurootologists". It is also very important to have a good neuromonitoring of the patient during the surgery. This preserves the function of patient's facial nerve and hearing ability. So it is absolutely crucial to preserve as much function of the patient. Hearing and facial nerve function has to be preserved. At the same time we have to eliminate as much acoustic neuroma tumor as possible. 1234 So for patients with acoustic neuromas it is most important to do detailed assessment of the tumor. We must understand the functional status of hearing and facial nerve function of the patient. It is crucial to determine the best method of treatment to remove as much of tumor as possible and to prevent recurrence. Dr. Peng Roc Chen, MD. Surgical skill of neurosurgeon is most important to treat acoustic neuroma successfully. 1234 Yes, absolutely. 1234 Dr. Chen, thank you very much for this very interesting discussion about cerebrovascular neurosurgery. Thank you for sharing the latest developments in neurosurgical field. You have a very extensive neurosurgical practice. You perform 700 neurosurgical operations in a year. This is a very large volume of surgical operations. We and our viewers are very fortunate that you shared with us your vast expertise in the field of neurosurgery. Thank you very much! 1234 Thank you very much for this interview. Dr. Peng Roc Chen, MD. I will be delighted to help with healthcare of any patient from anywhere in the world. Thank you. Thank you! Acoustic neuroma surgery or gamma knife? How to choose between radiosurgery and open brain surgery? How to find a neurosurgeon who can treat acoustic neuroma?