Diagnosis
Acoustic neuroma. Progressive hearing loss. Chronic cerebrovascular insufficiency.
Patient:
Female, 64 years old, Ukraine
Physician:
Prof. Dr. med. Martin Scholz, Head of Neurosurgery Department, Sana Hospital Duisburg
Patient’s Complaints & History:
Brain MRI scans revealed an extra-axial tumor, presumably an intra-extracanalicular left acoustic neuroma. There are signs of chronic cerebrovascular insufficiency. My overall condition is good, though I have recently experienced mild dizziness. A follow-up audiogram demonstrated progressive hearing deterioration in my left ear compared to last year's findings. Local physicians recommend observing the tumor's growth over time. Is surgery necessary at this stage?
Expert Opinion by Prof. Martin Scholz:
The imaging clearly demonstrates an acoustic nerve tumor—most likely an acoustic neuroma, also known as a vestibular schwannoma. This is a benign, slow-growing neoplasm.
Compelling medical indication for surgery exists when there is active compression of adjacent brainstem or cerebellar structures, regardless of absolute tumor volume. Prior to that threshold, surgical indications remain relative. However, if clinical symptoms progress or new neurological deficits develop, surgical intervention is advised.
We can perform a surgical resection of the neuroma, though auditory restoration in the left ear following surgery cannot be guaranteed. The surgical approach is a lateral suboccipital craniotomy with microsurgical tumor resection. Alternatively, adopting the conservative active-surveillance strategy recommended by your local doctors remains a valid option. If you choose observation, precise volumetric monitoring via serial MRI scans is mandatory: if the tumor demonstrates steady growth, definitive surgical removal will become necessary.
Patient’s Inquiry:
- What are the primary risks associated with this surgical procedure?
Doctor's Answer:
The baseline risk of complete hearing loss in the left ear following surgery is approximately 40% to 50%. However, if the tumor continues to grow without intervention, long-term hearing outcomes are generally similar. Facial nerve palsy and associated ipsilateral facial numbness occur in approximately 3% of cases. Additional surgical complications—such as secondary hemorrhage, impaired wound healing, cerebrospinal fluid (CSF) leak, or tumor recurrence—account for approximately 7% to 8%. The statistical mortality risk is 0.3%.