Acoustic Neuroma New Treatment Options Available for Acoustic Neuroma A new technique for treating acoustic neuroma enables neurosurgeons to visualize the facial nerve pre-surgery, improving the results of treatment for the benign but difficult-to-reach tumor. UCLA is among a handful of centers in the world that is using the technique, known as facial-nerve tractography. Acoustic neuroma is a slow-growing tumor that occurs at the junction of the brain, the nerve to hearing and the nerve to controlling facial movement. Its location puts patients at risk for serious symptoms, which include hearing loss, ringing in the ears, balance problems and facial numbness or tingling. The delicate location of the tumor also makes treatment complex, with risks that include a weakened facial nerve that leaves the patient with a crooked smile. The most recent development is facial-nerve tractography. UCLA is one of a handful of centers in the world that is performing this pre-surgical procedure, which increases precision by enabling the surgical team to visualize the small, thin facial nerve ahead of time. “When we weren’t able to see the facial nerve in advance, we had to guess based on the most common location. We’ve learned that the nerve is not always where we expect it to be,” says Isaac Yang, MD, UCLA neurosurgeon who specializes in treating acoustic neuroma, which also is known as vestibular schwannoma. “This allows us to plan the surgery in a safer, more thoughtful way so that we can preserve the facial nerve.” UCLA is also now treating acoustic neuroma with another minimally invasive method, radiosurgery. “Treatment of these tumors with radiation has shown varying levels of success in preserving patients’ hearing,” Dr. Yang notes. “The radiosurgery approach is more focused — stereotactic — targeting just the tumor.” His group recently completed a study showing that breaking down the radiosurgery treatment into multiple small doses increases the safety, improving hearing outcomes. Within the next year, Dr. Yang adds, the UCLA Acoustic Neuroma Program will begin utilizing a new approach to treating large tumors called adaptive hybrid surgery — first reducing the tumor size through conventional surgery and then using radiosurgery to treat what remains. These and other minimally invasive treatment approaches underscore the importance of early detection, Dr. Yang says. “When the tumor is smaller, we have more options, and our research has shown that the smaller the tumor, the better the outcomes in terms of their facial-nerve function,” he explains. Acoustic neuroma is most commonly presented as a one-sided hearing loss, or ringing in one ear. Patients experiencing such symptoms should be given an MRI to check for a tumor, Dr. Yang says. If a tumor is detected, treatment depends on a host of factors. “It can be a very personal decision, so we sit down and talk with the patient about the most minimally invasive, pain-free way of treating the tumor,” Dr. Yang explains. “For a patient who is a musician, hearing may be everything, while for another patient, the ability to smile — and thus preservation of the facial nerve — is most important. If an older patient has a large tumor, we are likely to take a more conservative approach, while for a younger patient we may want to be more aggressive — as long as we’re not risking the facial nerve.” For some patients, “minimally invasive” can mean doing nothing. “If it’s a small acoustic neuroma that isn’t causing any problems, we may just follow it — getting MRIs once a year or every few months to make sure it isn’t pushing against the brain stem,” Dr. Yang says. Top: Dr. Isaac Yang operating. Bottom: High-resolution MRI facial nerve tractography that visualizes the course of the facial nerve around the acoustic neuroma. The UCLA program’s emphasis on quality-of-life outcomes represents a departure from the way acoustic neuroma was treated in the past. “It used to be that the approach was to get the entire tumor out at all cost,” Dr. Yang says. “We want to take out as much as we safely can, as minimally invasively as we can, while leaving patients with the best possible quality-of-life outcomes, both in terms of their hearing and their facial muscles. At the end of every surgery I want my patients to smile — literally.” For more information about the UCLA Acoustic Neuroma Program, go to: acousticneuroma.ucla.edu 3 UCLA Physicians Update