Before the advent of the surgical microscope, surgery for an acoustic neuroma / vestibular schwannoma was limited to removing the tumor, which often resulted in hearing loss or facial paralysis since it was impossible to separate the tumor from the cranial nerve. With the introduction of the surgical microscope, intraoperative cranial nerve monitoring, and the endoscope, it became possible to remove or reduce the size of a tumor while preserving the facial nerve. Today, with advanced microsurgery and stereotactic radiosurgery techniques, it has become increasingly possible to remove or reduce an acoustic neuroma while preserving facial movement, hearing, and other functions.
Microsurgery: Surgery is the preferred treatment for most acoustic neuromas since it offers excellent odds of functional preservation with long-term results. Surgery can be used on a tumor of any size, and often becomes the only option for larger tumors that are pressing on critical structures. The surgery to remove an acoustic neuroma is extremely delicate and may take several hours, or even all day, to complete. The neurosurgeon will choose from several possible approaches; the choice of approach depends on the size of the tumor, the risk of damage from the tumor pressing on critical structures, and the age and health of the patient. Approaches have different rates of preservation of hearing and facial function, and are chosen based on the patient's existing level of functioning and surgical goals. Depending on the goals of surgery, your surgeon may decide to leave a small amount of tumor in order to preserve your nerve function in select cases. Residual tumor can be monitored, or treated with stereotactic radiosurgery.
Stereotactic Radiosurgery: Neurological surgeons can use stereotactic radiosurgery (highly targeted radiation beams directed at a tumor from multiple angles) to treat an acoustic neuroma in select cases, including for patients who may not be able to tolerate surgery, and those whose tumors are small. Radiosurgery is not an option for all tumors, and it may not treat some of the symptoms caused by the tumor; in carefully selected patients, however, radiosurgery can offer excellent results in terms of preventing tumor growth and preserving function. Radiosurgery is a rapidly developing technique requiring specially trained neurosurgeons using the most sophisticated equipment – such as the Gamma Knife and Novalis – that is usually only available in major medical centers. Treatment may be given in either a single session or in multiple lower-dose sessions (known as fractionated radiosurgery). Results are not immediate – the goal is to control growth of the tumor, or reduce it substantially, over a course of months or years.
More about the Acoustic Neuroma Program
The experts at Weill Cornell Medicine Neurological Surgery are fortunate to be part of the NewYork-Presbyterian Hospital team, with access to world-class surgical facilities and stereotactic radiosurgery equipment. We routinely appear on lists of America's best Hospitals (US News and World Report) and Top Doctors in New York (Castle Connolly), and our Neurosurgery program ranks as the #1 program in New York (Newsweek/Statista). Together, the NewYork-Presbyterian/Weill Cornell Medicine team is the best choice for skull base surgery and the treatment of acoustic neuromas.
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Reviewed by: Philip E. Stieg, PhD, MD
Last reviewed/last updated: October 2023
