Acoustic(bilateral) neuroma is a benign tumor that develops in the auditory nerve, which is also called an acoustic nerve. The acoustic nerve is responsible for transmitting the acoustic information to the brain and it is located in the inner ear. The incidence rate of acoustic neuroma is two cases per 200,000 population. This tumor occupies 11 - 12% of all brain cancers. Generally the disease is more likely to appear among the individuals between 35 and 45 years. There has never been cases of acoustic neuroma among children and teenagers.
Acoustic neuroma grows very slowly and it can develop for 2-3 years, until it begins to manifest itself. For some people the tumor may always retain a small dimension and in this case the patient does not require any special treatment, but only needs to be examined regularly by a doctor.
The cause of acoustic(bilateral) neuroma is still unknown. Usually it appears absolutely suddenly without any gradual aggravation. Sometimes acoustic neuroma is a sign of neurofibroma, which is a genetic disease. Neurofibroma is an autosomal disorder of a dominant character. This implies that there is a genetic mutation in the chromosome, which can be passed from the parent to the child. If this mutated gene has been present in the system both parents, the child's likelihood to develop the disease is 50%.
Stage first - tumor size does not exceed 1.9 - 2.7 cm, acoustic neuroma symptoms are the loss of hearing and light facial nerve paresis. Usually the patient loses hearing of one ear.
Stage second - the tumor has the size dimension of a walnut. Acoustic neuroma symptoms at this stage are more pronounced. Due to the pressure on the stem of the brain the patient experiences impaired balance and coordination of movements.
Stage third - the size dimension of the tumor reaches the size dimension of an egg. The tumor manifests in a sharp "squeezing" of the brain: there is a coarse nystagmus (horizontal intermittent motion). In rare cases, this ''squeezing'' may be life-threatening, because this part of the brain is responsible respiratory and motor centers.
Sometimes a tumor of a smaller size may be manifested stronger than the tumor of a larger size - everything depends on the location of the neuroma and on the organs, which are compressed. If the swelling is less than 1.6 cm in diameter there may be no symptoms.
The earliest manifestations of this neoplastic formations the damage of the acoustic nerve. This is a typical case for 95% of the cases, and the first sign is a ringing in the ears, which is accompanied by the hearing loss. The patient may also feel dizziness during the sharp turns of the head muscles or the body. Over some period of time, the acoustic (bilateral) neuroma leads to a complete loss of activity of the acoustic nerve, which is manifested in impaired vestibular function of the affected side. In addition, tumor development can damage the nerve, responsible for facial features, which is located close to the auditory nerve.
Diagnostics may include:
Hearing test is a diagnostic procedure of the acoustic(bilateral) neuroma that measures hearing in both ears;
The hearing test accumulates the response from the brain stem. The hearing capacity is measured by the electric impulses coming from the inner ear to the brain. Slowdown of the impulses or no impulse can indicate the presence of bilateral neuroma.
Electronystagmography is a test, during which the cold and warm water are poured into the ear canal and the results of dizziness and of eye movements are recorded and analyzed.
Examination for magnetic resonance imaging, which uses magnet waves to make clear pictures inside the head or body;
Nowadays there are three choices for the treatment of acoustic neuromas - surgery, radiosurgical intervention and palliative observation. Acoustic neuroma treatment is prescribed individually for each patient.
In case the tumors has the small dimension or when symptoms of tumor are minimized or absent, there is no particular need for surgery. The doctor just observes the growth of the neuroma and its manifestations. The patient is also recommended to undergo the regular study of hearing and computer imaging for the detection of acoustic(bilateral) neuroma growth rate. In case if there is a decrease in the hearing, it is necessary to resort to treatment.
There are several types of radiation therapy available at the doctor`s disposal. The most often used method is the so-called Gamma knife. This radiation is directed exactly on the location of the tumor. It does not require any big incisions and surgical interventions.
During the irradiation of gamma knife the position of the patient's head is fixed into a stereotactic frame. This procedure is conducted under the local anesthesia. During the course of radiation exposure the patient is patient is monitored by the voice as well as video surveillance of his condition. The process of irradiation is absolutely painless. Gamma Knife has a number of advantages over other methods of radioactive intervention.
The goal of every radiation intervention is to stop tumor growth. In this respect the Gamma knife is a perfect solution. It has been successfully used for the irradiation of the remaining tumors which are left after the operation in the deep-seated places where the surgeon's knife can not reach without damaging healthy brain tissue. Gamma knife treatment can vary from 5 weeks to 12 months and even years, depending on the tumor size and effectiveness of the irradiation. The success of radiation therapy is regularly monitored and later analyzed by the computed tomography.
Side effects of the gamma knife may include nauseated state of the patient, pain in the neck muscle and in the place where stereotactic frame was fixed. In the long run the side effects can be manifested in the paralysis of facial features and hearing loss.
The goal of surgery is the removal of neuroma, preserving the integrity of the nerve responsible for facial features. Another goal is to prevent the hearing loss. Surgical treatment is also performed under the general anesthesia. The operation consists of making the incision and craniotomy. Several days after operation the patient needs to be under observation in a hospital. The recovery period may last from 5 to 11 months. During this time the patient is checked in the hospital monthly.
Complications of surgery, as well as other surgical procedures include: infectious diseases, bleeding and dizziness after the anesthesia. As it was with radioactive intervention there is still a risk of facial features paralysis and hearing loss.Hide
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