This excerpt is from ANAC’s 40th Anniversary Celebration, held virtually in October 2023. It features a presentation by Michelle Gillespie, National Operations Director.

Understanding Your Treatment Options

Multi-disciplinary Care

• Skull-Base Neurosurgeon: Leads surgical planning and removal for tumors near the brainstem or cranial nerves.
• ENT – Head and Neck Surgeon: Collaborates on surgery when tumors involve the ear or internal auditory canal and evaluates ear health.
• Otologist / Neurotologist: Focuses on ear and nerve function; helps with surgical planning and post-treatment rehabilitation.
• Radiation Oncologist: Provides non-surgical radiation options and monitors tumor response.
• Audiologist / Vestibular Specialist: Measures hearing and balance function before and after treatment and assists with rehabilitation.
• Neurologist / Neuropsychologist: Assesses facial nerve and cognitive function.
• Radiologist: Performs imaging to establish baseline tumor size and location.

Key Points:

Consulting multiple specialists ensures a full understanding of risks, benefits, and outcomes.

Second opinions are encouraged if time allows.

Shared decision-making helps align your treatment plan with both medical needs and personal priorities.

Treatment Approaches

There are three primary approached for treating acoustic neuroma: 

Watch & Wait

What it involves: Regular monitoring with MRI scans and hearing/balance tests, typically every 6–12 months.

Why it’s used: Many acoustic neuromas grow very slowly or not at all. Observation can avoid unnecessary treatment and its potential risks.

Considerations:

• Symptoms may progress slowly, and some patients remain stable for years
• Tracking and reporting new or worsening symptoms is crucial
• Immediate treatment is usually reserved for noticeable tumour growth or increasing symptoms

Surgery

What it involves: Surgical removal of the tumour, usually through one of several approaches depending on tumor size and location.

Goals: Remove the tumour while preserving facial nerve function and, when possible, hearing.

Acute Recovery: Hospital stay is usually several days; initial recovery may include fatigue, balance issues, mild facial weakness, or nausea. Full recovery often takes weeks to months, depending on tumor size and surgical approach.

Considerations:

• Recovery can vary from a few weeks to several months
• Risks include hearing loss, balance issues, facial weakness, and other surgical complications
• Surgery may be recommended for larger or rapidly growing tumours, or if symptoms significantly impact quality of life

Radiation Therapy

What it involves: Targeted radiation (such as stereotactic radiosurgery) to stop tumour growth or shrink the tumour.

Acute Recovery: Usually outpatient with minimal recovery; mild fatigue, swelling, or temporary irritation may occur. Hearing and balance should be monitored afterward.

Why it’s used: Non-invasive alternative to surgery, often chosen for small- to medium-sized tumours or for patients who are not surgical candidates.

Considerations: 

• Hearing preservation is possible but not guaranteed
• Side effects may include fatigue, swelling, or delayed facial nerve changes
• Follow-up MRIs are required to track tumor response

Pre-Treatment Baseline Testing

Before starting any treatment, baseline testing is recommended, particularly for patients experiencing hearing loss, balance issues, facial nerve symptoms, or cognitive changes. Establishing a pre-treatment baseline helps your healthcare team:

• Assess your current level of function
• Gauge treatment outcomes and recovery
• Detect subtle changes over time

Recommended Testing

• Before treatment, baseline assessments help your team measure function and plan care:

  • Hearing: Audiologist evaluates current hearing and speech understanding.

  • Balance: Vestibular specialist assesses vestibular function.

  • Ear & Nerve Health: ENT / Otologist / Neurotologist examines ear structures and nerve function to guide surgical planning.

  • Facial Nerve & Cognitive Function: Neurologist / Neuropsychologist evaluates facial nerve and cognitive performance.

  • Imaging: Radiologist establishes tumor size and location with MRI.

  Why it matters: Baseline testing allows your team to track changes over time, optimize treatment outcomes, and plan rehabilitation if needed.

Key Takeaway:

Establishing these baseline measurements allows your treatment team to accurately monitor changes, optimize care, and maximize functional outcomes—physically, cognitively, and in daily life.