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Finding a Healthy Balance–Treating Acoustic Neuroma

Think about all the little movements you make throughout the day: Hopping out of bed to get to a meeting. Bending over to pick up your child for a hug. Adjusting your gait to the uneven terrain on your favorite jogging trail. Scooping up a ball to throw for Fido.

These motions are automatic, requiring no real thought or planning to execute. We all assume that our body can manage the usual tasks without incident. But what if a seemingly simple motion puts you at risk for a fall that could leave you injured?

That is the situation faced by 2,000 to 3,000 individuals in the United States each year who are diagnosed with a non-cancerous brain tumor called an acoustic neuroma, after symptoms such as hearing loss and balance issues begin to interfere with their lives.

Imagine having to plan literally every move your body makes. Each motion, from bending to kiss your child goodnight to walking across the street, is an exercise in concentration. While many of us could stand to focus more on the moment, those with acoustic neuromas do so out of a constant fear of injury. The acoustic neuroma, also called a vestibular schwannoma, is a non-cancerous tumor that affects the acoustic nerve. This nerve transmits information about sound and equilibrium from the inner ear to the brain.

This type of tumor isn’t actually a tumor of the nerve itself, but of the cells that surround the nerve. These cells, called Schwann cells, wrap around the nerve and insulate it, much like the plastic covering on copper electrical wire. As the tumor grows it compresses the nerve it surrounds. When the tumor affects the acoustic nerve, it can cause ringing in the ears, hearing loss, balance issues and vertigo.

As the tumor enlarges it can also press on structures in the surrounding area. This can mean headaches, facial numbness and weakness, double vision and vomiting. It can even cause hydrocephalus, a blockage of the flow of fluid around the brain and spinal cord.

Treatment for an acoustic neuroma can include a wait-and-watch approach for small tumors that are causing few symptoms. Surgical options are most common, however. Because these tumors are benign, a complete surgical removal can be a cure.

Tumors larger than 3 cm are usually treated with traditional neurosurgery—which involves opening the skull to expose the tumor to most effectively remove as much of it as possible. However, this style of traditional surgery can risk permanent damage to hearing, balance, facial movement and other functions, since the surgeon must work adjacent to delicate structures. This makes less invasive procedures more desirable, as they can precisely target tumor tissue in certain cases.

Gamma Knife radiosurgery is one such procedure. It uses focused beams of radiation rather than a scalpel to treat tumor tissue and spare the healthy nerve. In this way it can help preserve the function of the important structures near the tumor.

This approach is most valuable for small tumors and any remnants of tumor remaining after traditional surgery. Surgeons at Columbia University Medical Center/NewYork-Presbyterian Hospital have spent years refining their approach to the treatment of acoustic neuromas. At the Gamma Knife Center, led by Dr. Michael Sisti, almost 5,000 patients have been treated with Gamma Knife radiosurgery. More than 500 of those have been for acoustic neuromas.

In fact, Dr. Sisti has long been a leader in fine-tuning the treatment of acoustic neuroma using the different treatment options available. A paper published in the Journal of Neurosurgery looks at the results of 383 consecutive patients of Dr. Sisti. In it, Dr. Sisti and his coauthors are able to draw from his experience and offer guidelines for neurosurgeons in selecting the treatment for acoustic neuroma that is most effective while still preserving nerve function.

In addition, Dr. Sameer Sheth, Assistant Professor of Neurological Surgery at Columbia, demonstrated a microsurgical approach to the treatment of acoustic neuroma on video for the Journal of Neurosurgery. Using this approach, a surgeon can improve the chance of preserving important nerves that serve the face and head.

The team at The Brain Tumor Center at Columbia brings extensive experience to each patient encounter. Their years of leadership in developing treatments for acoustic neuromas uniquely equip them to understand the needs of their patients.

Some patients choose to postpone surgery. Instead, they make modifications to their daily routines to accommodate symptoms, and then they get on with the business of living. But it is comforting to these patients to know that, when the time comes for surgery, neurosurgeons like those at Columbia continually improve the level of treatment available for acoustic neuromas and other brain tumors.

To learn more about Dr. Sisti, visit his bio page here.
To learn more about Dr. Sheth, visit his bio page here.

patient journey

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