Surgery to remove an acoustic neuroma is both intricate and delicate. A smaller tumour usually generates fewer physical complications than larger tumours. As well, the configuration of the tumour on the nerve can affect the complexity of the surgery.
As a patient, you should expect to spend a few days in hospital including at least one-night post-surgery in intensive care to be carefully monitored. Longer hospital stays are standard for patients with larger tumours.
You can expect to have a follow-up MRI annually within five years post-operation, with the frequency of MRI's expanding as more years progress without detecting any growth.
Post Surgery Issues
Following your surgery, it is not uncommon to encounter issues as you recover. They can include:
Change in hearing
Hearing loss is not dependent on type of treatment you choose – whether it be radiation therapy, or surgery or watching and waiting. It is dependent on the location of your tumour in the bony canal, and the growth of the tumour. The eighth cranial nerve passes through the canal and its function is impacted as it grows. So the size of the tumour, as well as, the surgical approach can influence the loss.
It is important that you discuss the possibility of hearing preservation with your physician along with your treatment options. There are many options of hearing aids and assistive aides available.
Tinnitus (pronounced tin’-it-is) is an auditory perception of a sound in the ear that can only be heard by the person experiencing it. Each person who has tinnitus describes it in their own way. Many report that it sounds like a ringing, buzzing, humming, clicking, whistling or roaring. It can be loud or soft, constant or intermittent, can change in pitch, and be heard in one or both ears. In some rare cases, individuals experiencing tinnitus report hearing music. Tinnitus can be both an acute (temporary) condition or a chronic (ongoing) issue.
Although there is no cure for tinnitus and it can impact your quality of life, many patients develop coping mechanisms and strategies to lessen its impact.
Some patients experience headaches post-treatment, depending on the surgical approach and technique used. Treatments for these headaches include drug therapy, exercise, some alternative options, and surgery.
Balance issues or vertigo
Since the tumour usually arises from the vestibular nerve (which is responsible for balance), unsteadiness or balance problems may be one of the earlier symptoms of the tumour's growth. It is also very common for acoustic neuroma patients to experience balance issues before and after treatment. Some individuals experience vertigo and nausea which can be mild to severe, and may be noticeable only during certain activities, impacting their ability to work or drive. Balance retraining exercises can help.
The issues can be short term or long term, especially if the balance nerve has been compromised and needs time to heal. If the nerve became severed during surgery, the undamaged balance nerve on the other side of the head will eventually compensate for the damaged one. Vestibular therapy by a specifically trained physiotherapist can be effective for many individuals.
Facial weakness and pain
The proximity of the facial nerve on the seventh cranial nerve to the acoustic neuroma on the eighth cranial nerve means that often the facial nerve is affected during treatment. If the nerve is damaged, some facial function can be preserved, even when there is extensive damage. The nerve can also regenerate slowly and be repaired.
Non-surgical solutions such as exercise have proven to be beneficial. A registered physiotherapist with advanced training and specializing in facial neuromuscular retraining is an excellent resource to address facial issues.
Eye discomfort and eyelid issues
For individuals whose 5th, 6th or 7th cranial nerve has been affected by their acoustic neuroma, facial functions such as eye problems may arise. Individuals may have trouble blinking, excess moisture or dryness, double vision or eye sensitivity. Facial weakness can bring about incomplete eyelid closure on the affected side, which may lead to irritation of the cornea. Double vision (diplopia) may occur if there is pressure on the 6th cranial nerve, and there may be impairment of the muscles of the eyelids. By paying attention to eye care after acoustic neuroma surgery, potential eye problems can be managed successfully, allowing individuals to return to a normal lifestyle.
Cognitive and emotional issues
Brain fatigue, depression, attention, concentration and memory difficulties are not uncommon for patients. With their expertise in psychology as it relates to the brain and central nervous system, a neuropsychologist may be able to help. An evaluation to determine your course of therapy is the first step in addressing this common issue.
Taste and swallowing
For a few weeks post-surgery, your mouth may feel dry, and you may experience a change in your sense of taste. In most cases, this issue will not be prolonged. For swallowing problems, exercises directed by a speech pathologist, nurse or occupational therapist can help.