Removal of tumors of the Ear and Skull Base

Removal of Acoustic Neuromas

Acoustic neuromas should be removed surgically if possible. Hearing can often be preserved when the tumor is removed at an early stage, before the tumor grows too large; large tumors frequently cause irreversible hearing loss. Depending upon the size, stage, and placement of the neuroma, your physician may recommend surgery, radiosurgery, chemotherapy, radiation therapy, or a combination of these.

Traditional surgery is the standard method of removing acoustic neuromas. If the tumor can be removed completely, the recurrence rate is less than 0.1%. If it is not possible to safely remove the entire tumor, radiation therapy or chemotherapy may be used after excision to further shrink the remaining tissue. Different techniques may be used depending on the size and location of the neuroma. For example, in patients who still have hearing and have tumors under 2 cm in size, we may recommend the middle cranial fossa approach (above the ear) or retrosigmoid approach (behind the mastoid bone). The retrosigmoid approach, which requires brain retraction, can be associated with chronic headaches after surgery. Larger tumors may be better reached through the translabyrinthine approach (through the mastoid), as this avoids moving the cerebellum for access and it allows clear view of the facial nerve.

Risks of surgical removal of acoustic neuromas include hearing loss, facial weakness, facial numbness, dizziness, headache, memory loss, and cognitive dysfunction. Risks of spinal fluid leaks, permanent brain damage, and death are extremely rare. The best results come from centers of excellence such as Columbia Presbyterian, and from surgeons who are highly experienced in the specific treatments you are considering.

Stereotactic Skull Base Surgery

Stereotactic radiosurgery is a procedure in which ionizing radiation (rather than surgical incisions) is used to destroy tumor tissue. The radiation is targeted precisely at the tumor, using three-dimensional coordinates. Some evidence suggests that radiosurgery may pose a risk for inducing the growth of new tumors; this question is under current study. Overall, radiosurgery is considered as effective as traditional surgery and causes fewer complications.

Minimally Invasive Surgery - Current Research

Of special interest is research now in progress by Dr. Ian Storper in conjunction with the Department of Neurosurgery on minimally-invasive, stereotactic techniques for skull base surgery. This research aims to improve conventional skull base surgical procedures by simultaneously maximizing the removal of tumors and inflammatory lesions, and minimizing surgical risks and adverse effects. As is the case with minimally invasive surgeries throughout the body, advantages include reduced risk of infection and stress on the immune system, less bleeding, less pain and scarring, and shortened recovery time. The first major publication on minimally invasive, stereotactic skull-base procedures is in preparation and will be published ___.

Research on Head and Neck Oncology currently underway at Columbia Presbyterian