The Power of Collaboration: Acoustic Neuroma Treatment at Penn

Older woman is examined by an ENT

Acoustic neuroma is a noncancerous tumor that carries two passports: While they are often treated by brain surgeons, acoustic neuromas don't actually grow from brain cells.

“Acoustic neuroma is not really the right name for this tumor,” says John Y. K. Lee, Associate Professor of Neurosurgery and Otolaryngology at the Pennsylvania Hospital. “Classically, this is a vestibular schwannoma because the tumor grows on the vestibular nerve, which is the conducting wire from the balance system to the brain, located in the cerebellopontine (CP) angle.”

Because these tumors grow slowly, many patients don't notice the loss of balance. Instead, because the hearing and balance nerves are located so close to each other, most people who develop acoustic neuromas first experience symptoms such as hearing loss or ringing in the ear. And their first stop may be an Ear, Nose and Throat (ENT) specialist.

This dual passport is what makes acoustic neuroma treatment unique — it's also a reason to consider treating acoustic neuroma at Penn Medicine.

“At other hospitals, the departments that treat vestibular schwannoma work separately,” says Dr. Lee. “At Penn, we work together under one large roof: Penn Medicine.”

Improved Acoustic Neuroma Symptom Management

Extensive experience has created a unique approach to acoustic neuroma care at Penn. When ENTs and neurosurgeons collaborate closely, Dr. Lee explains, symptom management improves, from diagnosis to rehabilitation. So does the chance of saving a patient's hearing.

“This tumor type requires a multi-disciplinary approach between otorhinolaryngology (neurotology), neurosurgery, neuro-radiology and radiation oncology,” says Michelle Alonso-Basanta, MD, PhD, Chief, Central Nervous System Section.

“Penn doctors do a great job of respecting each other's expertise for the betterment of the patient.”

Douglas Bigelow, MD, Director, Division of Otology/Neurotology, came to Penn in 1991 and has watched both the ENT and Neurosurgery departments grow.

“We always had a very good relationship and would consult each other on these cases,” Dr. Bigelow tells us. Hundreds of cases later, “the relationship has become seamless.”

The work has paid off. Dr. Bigelow and his colleagues authored the most highly quoted paper in the field of acoustic neuroma outcomes data: The Penn Acoustic Neuroma Quality of Life (PANQOL) scale, which is used to evaluate patients around the world.

When to Treat Acoustic Neuroma

Because acoustic neuromas are benign (noncancerous), they don't spread to other parts of the body. They typically grow very slowly, and sometimes they don't grow at all.

So not only do Penn physicians have time to consult each other, they encourage their patients to use this time wisely as well. “I encourage patients to do a lot of research and look around,” Dr. Lee tells us. “They have time to make a decision.”

“In fact,” he continues. “My acoustic neuroma patients are the most educated about their condition out of all of my patients. They'll get second, third, fourth opinions. And I want them to do so.”

The goal of acoustic neuroma treatment is to make a decision that everyone is comfortable with. Often that decision is to simply watch and wait. This phase can last for several years.

However, if the tumor grows or begins to affect hearing or balance, treatment may become necessary.

Acoustic Neuroma Treatment at Penn

If intervention is needed, the patient's treatment team will present a variety of options, from radiation to surgery.

“Every patient is looked at individually,” Dr. Bigelow says. “There's no one-size-fits-all approach. We offer a lot of options and give patients the choice.”

At Penn, choosing a particular treatment option doesn't have to mean losing your doctor. “At other centers, you might see surgeons who specialize in one type of procedure," Dr. Lee says. Penn neurosurgeons are trained in a variety of procedures in addition to conventional surgical options, including Gamma Knife® and CyberKnife®. The team’s radiation oncologists are trained in Gamma Knife, CyberKnife in addition to other types of proton radiation.

Dr. Lee himself is internationally known for innovations in endoscopic (minimally-invasive) techniques for acoustic neuroma surgery and CP angle surgery.

“If an acoustic neuroma is large or if the patient is not a candidate for surgery, radiation may be the preferred treatment,” Dr. Alonso-Basanta tells us.

“The goal of radiation is to prevent tumor growth. In the majority of cases, you may note a decrease in volume over many years. However, if there is no change in volume over many years, that is considered to be a controlled tumor.”

Acoustic Neuroma Follow-up Treatment

After treatment, the ENT team will have a primary role in any necessary rehabilitation. This may include hearing aids, implantable hearing aids, cochlear implants, auditory brainstem implants or other devices for hearing loss. Additionally, the ENT works with patients to optimize balance and reduce symptoms of dizziness as quickly as possible.

Dr. Bigelow typically follows up with his acoustic neuroma patients up to ten years after treatment.

“Whether you choose to do, surgery, radiation or observation, we will be there for all of it,” he says. “We will continue to follow you regardless, so that you don’t feel like we’re pushing you in only one direction.”

Choose an Experienced Acoustic Neuroma Surgeon

Dr. Lee recommends seeking out a center that treats a large volume of acoustic neuromas and other conditions that occur in that area of the brain. Because acoustic neuromas are uncommon, he tells us, it’s important to find a team of surgeons with lots of experience in this area.

“Patients should go places that do a lot of these and in particular they should see surgeons that do a lot of these.”

Unfortunately, the number of surgeons performing a high number of acoustic neuroma surgeries is dropping. The surgery itself can take more than 12 hours to complete, making it particularly demanding. For this reason, many centers refer these difficult cases to Penn.

However, Dr. Lee continues to perform approximately one hundred CP angle surgeries a year, with a mid-career total of nearly one thousand. “Many studies have shown that expertise comes with surgical volume, and I feel that I am on the right track here at Penn to perform the highest volume of acoustic neuroma and CP angle surgeries in the region.”

His approach to acoustic neuroma surgery includes extreme concentration and utmost dedication to the surgery. He aims for complete resection (removal) of the tumor during every surgery, unless it presents too much risk for the patient. The decision of how much, if any, tumor to leave behind is what makes experience so valuable for this procedure. In some cases, leaving a small amount of the edge of the tumor along the facial nerve will reduce post-operative weakness of facial movement. This small amount very rarely causes problems for the patient in the future, and determining that balance requires significant experience.

“It’s this kind of attitude that develops the grit needed to become an excellent surgeon that can provide excellent results consistently.”

Acoustic Neuroma Patient Story

Melissa Drake Acoustic Neuroma Patient Melissa had an acoustic neuroma, read her story to learn about her diagnosis and how Dr. Lee successfully removed her tumor. 


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