Note: Complete tumor removal is no longer a priority in every case.
Observe (so-called “watchful waiting”) as long as hearing is stable and the tumor is not growing!
Indication
- Small tumors (max diameter of < 10-15 mm or volume < 1.7 cm 3):
- Observational waiting (so-called “watchful waiting”), esp. if these are purely intracanalicular and cause few symptoms
- hearing-preserving surgery and chance of permanent cure possible; exceptions:
- Tumors that completely fill the fundus of the internal auditory canal or grow primarily in the cochlear fossa, intracochlear, or intralabyrinthine (in these cases, complete removal usually results in loss of hearing)
- Medium-sized tumors (max diameter of 15-30 mm; volume: 1.7-14 cm 3).
- With partial brainstem compression due to extension in the cerebellopontine angle → complete removal by microsurgery through a retrosigmoid approach; there is a good chance of hearing preservation in this case
- If necessary, also observing waiting (so-called “watchful waiting”) to assess the growth behavior
- Large tumors (stages 4a and 4b according to Samii/s. u. classification; max. diameter > 30 mm; volume up to 100 cm 3).
- Observational waiting (so-called “watchful waiting”) only in exceptional cases.
- Only in isolated cases is still with radical tumor removal, a functional hearing to preserve
- The functional preservation of the facial nerve should be inversely proportional to the size of the tumors [2
1st/2nd order.
Total removal of the tumor while sparing the nerves / brain; several access routes can be distinguished:
- Translabyrinthine approach (through the labyrinth of the inner ear); this approach is mainly chosen when hearing is already destroyed by the tumor
- Transtemporal approach (through the temporal bone area); this approach is chosen mainly when the tumoris too large and lies exclusively or predominantly still in the bony auditory canal; both facial nerve and auditory nerve can be preserved in the process
- Suboccipital approach (via the posterior fossa); is the preferred choice for medium and large acoustic neuroma; both facial nerve and auditory nerve can be preserved in this approach
Possible complications
- Facial nerve paresis (for prophylaxis: functional facialis preservation by intraoperative monitoring).
- Hearing loss (for prophylaxis: monitoring of hearing function; intraoperative functional monitoring of the cochlear nerve).
- Surgery-related damage to other cranial nerves, e.g., trigeminal nerve (cranial nerve V) and oculomotor cranial nerves (cranial nerve VIII) (very rare)
- Ischemic complications and rebleeding (approximately 1%).
- Postoperative scar and occipital neuralgia/nerve pain (rare).
