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Acoustic Neuroma

Overview

An acoustic neuroma is a benign, noncancerous, usually slow-growing tumour of the 8th cranial nerve (auditory nerve), located in the ear canal. The tumour is most commonly located where the nerve leaves the skull cavity and enters the bony structure of the inner ear. Symptoms vary with the size and location of the tumour.


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Causes

The cause is unknown, however, there is a high association of acoustic neuroma with neurofibromatosis type 2(NF2). NF2 is an inherited disease which is characterized by development of symmetric, non malignant tumours in the auditory-vestibular nerve, transmitting information from the inner ear to the brain. Acoustic neuromas are relatively uncommon as a whole, but they are among the most common tumours of the head, affecting approximately 1 out of 100,000 people.


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Signs & Symptoms

The symptoms seen are : ringing in one ear (tinnitus); hearing loss in the affected ear; difficulty understanding speech (out of proportion to total hearing loss); dizziness; unsteady walk; abnormal sensation of movement (vertigo); headache when one wakes up in the morning; aggravated by lying down, when in a reclining position or standing up; increased by coughing, sneezing, straining, lifting (Valsalva maneuver). There is also numbness and pain on the face and one ear; nerve pain or pain along the path of a specific nerve on one side only (unilateral); face droops on one side; transient vision abnormalities; and pupil in only one eye is enlarged and dilated (unilateral).

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Prevention

Because the cause is unknown, prevention is also unknown.


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Treatments
Fractionated Radiotherapy Modern Medicine

This technique was developed when several centers who used linear accelerator irradiation technology were not satisfied with the results or accuracy after single fraction irradiation (radiosurgery). To decrease the cranial nerve morbidities, radiation was delivered over multiple sessions (fractionation). The goal of this approach is to weaken the effect of each radiation administration and try to maintain brain or nerve function. This also weakens the effect of the radiation on the tumor target.

Gamma Knife Radiosurgery Modern Medicine

This technique is a stereotactic radiosurgery using the Gamma Knife (Elekta Instruments, Atlanta GA) supplemented with local anesthesia and intravenous sedation.

Surgical Resection Modern Medicine

It is important to observe the development of the tumor before beginning any form of treatment. Surgical Resection is done to remove the tumour. Depending on the goal of the treatment, severity and size of the tumour, three kinds of routes can be taken : suboccipital retrosigmoid, translabyrinthine approach (for large tumours) and "middle fossa" approach. The goal could be life saving, or avoiding neurological deficits like hearing loss, facial weakness or balance disorders.

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