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Diagnosed with anAcoustic Neuroma?

Don’t Panic!Here are some answers which we

hope will be helpful to you

British Acoustic Neuroma Association. Registered Charity No: 1024443

BANA is sincerely indebted to Mr H Gatiss and Mr & Mrs T Gibbons forfunding the cost of printing these leaflets to provide

information for acoustic neuroma sufferers throughout the UK.

Visit us at... www.bana-uk.com

British Acoustic Neuroma Association CIO is a registered charity (No: 1165065 - formerly 1024443), founded in 1992 by a

patient-led group to provide support and information for people affected by acoustic neuromas and to encourage

research into the condition and rehabilitation methods. We are the only national UK charity dedicated to acoustic neuromas

and the related symptoms.

Member community services include a website forum for information sharing about diagnosis, pre or post treatment topics, or

anything acoustic neuroma related. We have online social networking groups, a Support Register of patients willing to share similar experiences, a periodical magazine and we host a number

of local area support group meetings.

Whilst many of BANA’s services involve membership,we endeavour to always assist any enquirer. Our office is manned

Monday to Friday, generally 8.30am to 4.00pm.

BANA is a self-funding charity with many services operated by dedicated volunteers. If you would like to support our work,

please consider joining as a member, by making a donation or actively fundraising.

Your support will make a real difference. Thank you.

“Information and support from BANA membersmeans a problem shared is problem halved.”

David (BANA member)

Tapton Park Innovation Centre, Brimington Road, Tapton, Chesterfield, S41 0TZ

Tel: 01246 550011 | Email: admin@bana-uk.com

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Radiosurgery is a method of treating brain tumours with radiation, to kill the tumour cells or to attempt to restrict their capacity to grow. Whilst this does not remove the tumour, it may cause some shrinkage over time, and it is often advised to treat deep-seated tumours that may be difficult to reach or remove by surgical methods – although not all acoustic neuromas are suitable. Radiosurgery is available in the UK in a few specialised neurological centres and can be carried out by Gamma Knife, by modified linear accelerator (Linac), or by CyberKnife©.

The word stereotactic means locating a site using three-dimensional coordinates, usually captured by modern day imaging techniques, and it is this that assists practitioners to hone in on the precise point of the tumour.

Stereotactic Radiosurgery (SRS) is the general term used today for administering radiation to treat conditions of the head and brain. SRS can be delivered in one treatment dose or in smaller doses over a number of sessions. All doses, whether in single or multiple parts, are calculated based on the size of the tumour, and the treatment is individualised to the patient and theacoustic neuroma itself.

Due to the requirement for absolute accuracy in administering radiosurgery, patients must remain motionless during treatment, and a variety of means are used depending on the device. These include a metal frame that attaches to the device, which is measured to the size of the patient’s head and fitted directly to the skull following localised anaesthesia, or a thin plastic mask applied over the face.

An overnight stay in hospital is generally not required for radiosurgery treatments and some people are able to return to their normal routine immediately afterwards.

STEREOTACTIC RADIOSURGERY (SRS)

Tapton Park Innovation Centre, Brimington Road, Chesterfield, S41 0TZ | Tel: 01246 550011 | Email: admin@bana-uk.com

www.bana-uk.com

WHAT IS AN ACOUSTIC NEUROMA (VESTIBULAR SCHWANNOMA)?An acoustic neuroma (Vestibular Schwannoma) is a brain tumour which accounts for a small percentage of all brain tumours. Acoustic neuromas are benign (not cancerous) and usually, but not always, are slow growing. Some may grow and then stop growing altogether.

It is currently thought that one-sided sporadic acoustic

neuromas arise due to a spontaneous mutation on

chromosome 22, producing an overproduction of Schwann

cells. Schwann cells comprise the covering of nerve sheaths,

in this case usually the upper or lower balance nerves, and

as they multiply produce a small lump or tumour filling the

canal housing these nerves.

A tumour expanding in the canal can compress the hearing (cochlear) nerve and produce hearing loss and tinnitus, unsteadiness or imbalance. In many patients these initial symptoms are mild and deceptive, because they are also associated with many other less serious conditions. As a result acoustic neuromas may initially go undiagnosed.

The continued growth of the tumour may touch the fifth cranial nerve (trigeminal) and then facial tingling and subsequent numbness of the facial skin may occur. Continued growth with brainstem compression can produce further symptoms and clearly,if untreated, there is a risk to life if the tumour compresses the brainstem significantly. It is therefore important to diagnose and if necessary treat these tumours from an early stage.

The diagnosis of this condition is made after the patient reports these symptoms. There is then a careful examination of the ear and the hearing and balance systems, along with a complete neurological examination and then sophisticated audiometry to test the hearing along with a clinical balance assessment. An MRI scan is used to make the final diagnosis and this is the gold standard diagnostic test.

HOW IS IT FOUND?

There are three modern management options for this tumour, depending upon its size, location and the severity of the symptoms. One option is watch, wait and rescan management, alternatively known as wait and watch. The second management option is intracranial surgery to remove the tumour, and the third option is stereotactic radiotherapy, whether in single or multiple doses. The latter has a high percentage chance of stopping the tumour from growing but will not eradicate the tumour mass.

WHAT TREATMENTOPTIONS DO I HAVE?

Unless the tumour is causing distressing symptoms, as a general rule most patients will opt for watch, wait and rescan, i.e. monitoring of the tumour. In many cases they do not continue to grow and may not need to be treated.

It is these symptoms that determine quality of life and, therefore, will influence your choice of management. These symptoms include hearing loss on the side of the tumour which may become worse over time even if the tumour does not grow, a worsening of tinnitus and possibly episodes of dizziness or problems with your balance.

WAIT AND WATCH

because of the important site of the tumour in relation to the brainstem and cerebellum and the necessary manipulation during surgery, neurological damage may be increased at least temporarily after surgery. This may include total and permanent one-sided hearing loss where formerly there was only a mild hearing loss, problems with balance, facial weakness, eye discomfort and headaches.

Surgery is a complex procedure that can take anything from three to eight hours to perform depending upon the size of the tumour, and in some instances it can take longer. Surgical treatment necessitates a number of nights stay in hospital immediately after the operation, in a High Dependency Unit in some cases.

In some cases it may not be possible to completely remove the tumour, and patients will require monitoring by MRI scanning afterwards to check that there is no regrowth in the residual remnant. Interval scanning in these cases is very important. If only a small portion of the tumour remains, or a fragment of tumour capsule, it is very unlikely to grow.

SURGERY

The aim of acoustic neuroma surgery is to remove the tumour and preserve the facial nerve and to attempt to preserve your quality of life. This is, however, major intracranial surgery and