Acoustic neuromas can now be easily treated with Advanced Cyberknife Radiation therapy

• Dr Aditya Gupta, Director, Neurosurgery and Cyberknife Centre, Artemis Hospital

Acoustic Neuroma which is also known as vestibular schwannoma, is a benign tumour which is non cancerous and usually grows slow. It develops on the hearing nerve that leads from inner ear to brain. The branches of this nerve influence the balance, hearing and the pressure from an acoustic neuroma that can cause hearing loss, ringing in your ear and unsteadiness.

Identify the early symptoms!

The symptom starts with the gradual loss of hearing in one ear and the problem is accompanied by the ringing in the ear also with the feeling of fullness in the ear. The acoustic neuromas can cause the sudden hearing loss. The symptoms that occur over time includes:

1. Vertigo
2. Facial numbness and tingling
3. Problem with balance
4. Facial weakness
5. Change in taste
6. Difficulty in swallowing
7. Headaches
8. Clumsiness
9. Mental confusion

Cyberknife radiosurgery has revolutionized the treatment of acoustic neuroma

What Causes Acoustic Neuroma?

The cause of the development of acoustic neuroma is unknown. A rare hereditary disease “Neurofibromatosis” is associated with some cases of acoustic neuroma.

Acoustic Neuroma can also be caused by:

• Continuous exposure to loud noise
• Radiation on face and neck can lead to acoustic neuroma many years later.

In 1 out of 10 people, an acoustic neuroma is caused by neurofibromatosis type 2 (NF2). NF2 can run in further generations also. Person suffering from NF2 can develop benign tumours on the spinal cord and the coverings of the brain.

Acoustic neuromas is formed through type of cells called a Schwann cell. These cells cover the nerve cells of the body. That is why this tumour is also called  vestibular schwannoma. Acoustic tumour grows with the nerve in the brain. This nerve is called cranial nerves or the acoustic or vestibulocochlear nerve. This nerve is responsible to control the sense of hearing and also the balance of the body. Acoustic tumour is rare and in between1 and 20 people in every million worldwide are diagnosed each year with an acoustic neuroma. And it’s more common in women than men.

Acoustic Neuroma Treated With Cyberknife

According to the survey published in the international journal ‘Sage Journal’ two out of 100,000 people aged 30 to 60 develop acoustic neuroma, which makes this condition incredibly rare.

The Acoustic Neuroma treatment depends on the size of the tumour. If the tumour is large, there will be more medical problems. The small size of the tumour is less than 1.5 cm, medium is between 1.5 cm and 2.5 cm and large is 2.5 cm or larger. Small tumours require cyberknife due to their size while the larger tumours typically require surgery.

The newest radiation therapy option for acoustic neuroma is a form of radio surgery that requires absolutely no incisions using new technology called CyberKnife. Patients treated with this new non-invasive experience minimal to no side effects.

Radio surgery techniques can stop tumours from growing by using high-dose exact precision radiation treatment. Patients treated by CyberKnife® technology experience minimal to no side effects, and receive treatment on an out-patient basis. After patients undergo radio surgery, the acoustic neuroma is closely monitored to confirm the growth has stopped or that the tumour has begun to shrink.

The surgery includes advanced robotics, tumour tracking and imaging capabilities. The patients with particular symptoms like pressure symptoms, tinnitus, or imbalance may be best treated with surgery because surgery will relieve the symptoms more rapidly. Also, the large tumours mean the size greater than 3.0 cm are best treated with surgery because these tumours can sometimes swell and cause obstruction in the flow of cerebrospinal fluid.

Treatment starts with the CT scan. The CT scan image is then imported to the CyberKnife Treatment Planning System. The oncologist team make a plan to treat the tumour while avoiding surrounding important sensitive structures.

The process involves typically 1 or 3 sittings and per sitting lasts for maximum 40 minutes. The treatment does not require any sedation and is painless.

The chances of side effect are next to negligible. Hearing is preserved and achieved in 50-75% of the time. Temporary numbness of one side of face is 2-3%. After the CyberKnife surgery tumours stabilize in size then shrink with time slowly.