As you begin to explore your vestibular schwannoma treatment options, it can be helpful to have an understanding of the condition itself as well as why your neurosurgeon may recommend one approach over another. The following information will walk you through each potential treatment option and explain the benefits and risks of each, helping you better understand the differences.
About Vestibular Schwannoma
Vestibular Schwannomas, also called acoustic neuromas, are benign brain tumors which develop from one of the cranial nerves, the vestibulocochlear nerve. This nerve is responsible for both hearing and balance, which may help explain some of the symptoms you have been experiencing.
Because these tumors are benign, they do not spread to other sites of the body or invade neighboring tissues. However, because there is not much extra room within the skull, they tend to put pressure on nearby tissues, also leading to symptoms and potentially causing damage. The size and location of your tumor will help determine which of the vestibular schwannoma treatment options is most appropriate for your individual case.
Most people with vestibular schwannomas only have them on one side of the brain. However, some patients with a rare hereditary disorder called neurofibromatosis type 2 (NF2) may have them bilaterally. Though NF2 patients have a genetic link to their tumor development, most vestibular schwannomas develop spontaneously.
Vestibular Schwannoma Treatment Options
Because vestibular schwannomas vary in size and location, your doctor will recommend the treatment option he feels is most appropriate for you based on your individual condition and health history. Potential vestibular schwannoma treatment options include observation, stereotactic radiosurgery, surgical removal and a combination approach.
Observation
For patients who have very small and asymptomatic tumors, observation and monitoring may be preferable to immediate treatment. Small vestibular schwannomas are often found incidentally during imaging ordered for other reasons, such as accidents. When they are very small (3-4 millimeters), they may stop growing and never produce symptoms.
This approach avoids the risks generally associated with surgery and a fair percentage of patients will never require further treatment. However, if left untreated, there is a chance of the tumor growing and leading to vestibular schwannomas symptoms of hearing loss over two to three years. If your doctor recommends observation and monitoring, it is vital you adhere to your follow-up schedule so any tumor growth can be recognized as soon as possible.
Stereotactic Radiosurgery/Gamma Knife
Stereotactic radiosurgery is a form of radiation therapy that delivers a focused beam directly to your tumor, sparing healthy surrounding tissues. Many vestibular schwannoma patients can be treated in a single session, though this depends on your individual tumor and condition.
Because of its minimally invasive nature, stereotactic radiosurgery offers many benefits to eligible patients and can be just as effective as traditional surgery. It is not a surgical procedure, so open surgery and the risks it carries are avoided, such as infection or surgical complications. There is also less risk of injuring the facial nerve or hearing nerve.
A risk of stereotactic radiosurgery is that patients may experience headaches and fatigue following treatment. However, this is true of all radiation therapy and the unpleasant side effects are far less than those associated with traditional whole brain radiation therapy because of the focused nature of the procedure.
Surgical Removal
Sometimes, traditional surgical removal is the most appropriate option, particularly for tumors that are large. When a vestibular schwannoma is large, the tumor often presses on the brain stem, which does not tolerate radiation therapy well. Surgical removal will generally be the treatment of choice for these situations and the surgeon may choose to remove all or just part of the tumor.
An advantage of surgical removal is that once the tumor has been removed, it is not likely to return. However, if any of the tumor remains, surgery can be used in conjunction with radiation therapy to eradicate what was not removed.
One disadvantage of surgery is there is a chance of facial muscle weakness following the procedure, particularly if the entire tumor is removed. This often resolves after a few months, but some patients may experience longer-lasting symptoms. Other potential complications include hearing loss, long-term difficulties with balance and coordination, headache, fatigue and infection or pain at the incision site.
Your Condition, Your Treatment
Because no two patients are exactly alike, it’s important you work with a doctor experienced in the treatment of vestibular schwannomas. There are reasons to recommend some vestibular schwannoma treatment options over others depending on your individual health history, the size of your tumor and what symptoms you are experiencing.
If you find you still have questions about why your doctor has recommended the treatment he or she has, or perhaps you are interested in a treatment option that was never discussed with you, be sure to bring your concerns up at your next appointment. Your doctor will be able to explain exactly why one vestibular schwannoma treatment option may be preferable in your individual case.
