Brain Nerves

So-called neurinomas (also called schwannomas) are benign tumors of the brain nerves and usually show slow growth. The neighbouring structures are relocated and displaced, yet they have time to adapt causing symptoms to appear rather later than sooner. Malignant and fast-growing tumors are very rare.
The most common tumor in the cranial fossa is the acusticus-neurinoma, emerging from supporting cells of the vestibular nerve. Thus it is also called a vestibular schwannoma.

Symptoms

The most common symptom of the acusticus-neurinoma are auditory failures, starting with acute hearing loss or tinnitus. Should the tumor affect other nerves, sensorial failures or lack of face movement, double images or swallowing defects can arise. Very large tumors can affect the brain stem and result in paralysis, walking problems and failure of the cerebellar function. If pathways for water are blocked, headaches, nausea and cognitive disorder can occur.

Therapy

Depending on the size and location of the tumor, increase or decrease in hormonal production, as well as age and symptoms of the patient, our medical centre offers three general methods of treatment:

• • waiting observantly with regular MRI-checks to control the course of the disease
  • Endoscopic removal of the tumor
  • Medicinal therapy

In older patients or small tumors, which do not show symptoms, a regular MRI-check is sometimes the best way. If the tumor does not show steady growth, a therapy may not be necessary.

If the tumor, on the other hand, shows a clear and continuous growth, if it is symptomatic or takes up too much room, an intervention is recommended.
Younger patients are more likely to receive an indication to undergo surgery. Especially in small tumors, there is a good chance to remove the lesion entirely and preserve hearing. If, in older patients, a serious accompanying illness makes narcosis dangerous, or the patient does not want an operation, an alternate treatment, using stereotactical radiological therapy (e.g. the Cyberknife), can be performed.

In our medical centre, acusticus-neurinomas are resected using endoscopically assisted microsurgical techniques. During surgery, a permanent electrophysiological monitoring is performed to control the functions of hearing and facial nerves. The inner ear canal is largely visible with the endoscope. Small rests of tumor, which are not visible with the microscope, can thus be removed directly. In larger tumors, we make use of the intra-operative CT to control the resection of the tumor in real time and rule out surgical complications.

In our experience, the combined use of endoscopic, navigated “keyhole access” and functional surveillance shows the best results for brain surgery.