Acoustic neuroma: surgery or gamma knife? Medical second opinion helps to select 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 paradigm "I can only hurt you by treating you”. Complete removal of acoustic neuroma? Risk of damage to adjacent cranial nerves and brain stem? Balance is difficult to achieve in treatment of acoustic neuroma. Acoustic neuroma treatment medical second opinion. Dr. Anton Titov, MD. 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. Dr. Anton Titov, MD. Acoustic neuromas arise from the balance system nerves. Acoustic neuroma is an example of tumor when 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 brain stem. This tumor often grows slowly. Often hearing loss is 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 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. Acoustic neuroma treatment. Medical second opinion. 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? Dr. Anton Titov, MD. What is acoustic neuroma? What are typical symptoms of acoustic neuromas? Please talk about advances in treatment of acoustic neuromas. Dr. Philip Theodosopoulos, MD (Neurosurgeon, Director, Skull Base Tumor Program, UCSF). 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. Dr. Philip Theodosopoulos, MD. We call these tumors acoustic neuromas. But there 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. It is 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 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 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. Dr. Philip Theodosopoulos, MD. 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. Dr. Philip Theodosopoulos, MD. Acoustic neuroma therapy is a whole new field. We have a multi-center clinical trial that is still going on. I am one of 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 example of a condition in neurosurgery that is so specialized in its treatment. Because acoustic neuromas are mostly treated at very specific centers. Dr. Philip Theodosopoulos, MD. 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 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. Dr. Philip Theodosopoulos, MD. 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. Dr. Philip Theodosopoulos, MD. Treatment of acoustic neuromas can really challenge the neurosurgeon. Neurosurgeon has to really understand what is 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?
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