What Exactly is an Acoustic Neuroma?

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First, what's most important:

• IT IS benign(not cancerous)
• DOES NOT spread to other parts of the body
• Grows slowly(typically 1-2 mm per year)
• IS treatable with excellent results

The simple technical explanation:

Acoustic neuroma (also called vestibular schwannoma) is a tumor that grows on the nerve connecting your inner ear to your brain.

Where does it come from?
It originates from Schwann cells, which are the cells that "wrap" nerves like insulation on an electrical wire. For reasons we don't fully understand, these cells start to multiply and form a tumor.

Where exactly does it grow?
Despite its name ("acoustic"), the tumor usually grows on the vestibular portion of the VIII cranial nerve (the balance nerve), not the auditory portion. It grows in a space called the cerebellopontine angle, between your inner ear and your brain.

How common is it?

• Represents 8-10% of all brain tumors
• Incidence: 1 per 100,000 people per year
• Most common between ages 30-60
• Slightly more frequent in women
• Usually unilateral (one side only)

Why did this happen to me?

In 95% of cases, it occurs spontaneously without identifiable cause. It's not your fault.

In a small percentage (5%) it's associated with a genetic condition called Neurofibromatosis type 2 (NF2), where tumors appear on both sides. If your neuroma is bilateral, you'll need genetic evaluation.

Symptoms: Why It Was Discovered in You

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Acoustic neuroma is sneaky: it grows so slowly that your brain "adapts" and symptoms appear gradually.

🎯 The classic triad (most common):

1. Hearing loss in ONE ear (90% of patients)

• Progressive and gradual (rarely sudden)
• Especially difficulty understanding words
• Worse with background noise
• May notice difference when using phone

2. Unilateral tinnitus (70% of patients)

• Ringing, buzzing or roaring in ONE ear
• Constant or intermittent
• Sometimes the first symptom

3. Balance problems (60% of patients)

• Unsteadiness when walking
• Occasional feeling of "dizziness"
• Rarely severe vertigo (brain compensates)
• May worsen in darkness

⚠️ Symptoms of larger tumors:

When the tumor grows and presses on adjacent structures:

Trigeminal nerve compression (V nerve):

• Facial numbness on the same side
• Facial tingling
• Decreased sensation

Facial nerve compression (VII nerve):

• Mild facial weakness (rare before surgery)
• Facial spasms

Brainstem compression:

• Headaches (especially occipital)
• Coordination problems
• Swallowing difficulties
• Diplopia (double vision)

Hydrocephalus (giant tumors):

• Severe headache
• Nausea/vomiting
• Visual changes
• Altered mental status

Why did it take so long to discover?

Many patients tell me: "Why didn't my doctor think of this earlier?"

The reality:

• Unilateral hearing loss is common and has many causes
• Symptoms are subtle at first
• High index of suspicion is needed
• MRI is the only way to confirm it

The Diagnostic Process: From Suspicion to Certainty

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1. Initial clinical evaluation:

Directed medical history:

• Chronology of auditory symptoms
• Laterality (which ear?)
• Vestibular symptoms (dizziness, imbalance)
• Associated neurological symptoms
• Family history (NF2?)

Neuro-otological examination:

• Otoscopy (rules out middle ear causes)
• Cranial nerve evaluation
• Balance and coordination tests
• Facial sensation assessment

2. Audiological studies (CRITICAL):

a) Pure tone and speech audiometry:

Typical neuroma pattern:

• Unilateral sensorineural loss
• Speech discrimination disproportionately poor for degree of loss
• High frequency loss first

b) Impedance audiometry:

• Absent or elevated stapedial reflex
• Reflex decay (rapid fatigue)

c) Auditory Brainstem Response (ABR):

The gold standard test before MRI:

• Absence of waves or conduction delay
• Sensitivity >95% for neuromas >1 cm
• If abnormal → REQUIRES MRI

3. Magnetic Resonance Imaging (MRI) with contrast (gadolinium):

What does MRI show?

• Exact location: Internal auditory canal vs. cerebellopontine angle
• Precise size: In 3 dimensions
• Relationship with structures: Facial nerve, brainstem, vessels
• Cystic component: If it has fluid areas
• Extension: If there's brainstem compression

Why with contrast?

Gadolinium "lights up" the tumor in the image. Without contrast, small tumors can be missed.

4. Other studies (when indicated):

Vestibular tests:

• Videonystagmography (VNG): Evaluates vestibular function
• Caloric test: Detects vestibular paresis
• vHIT: Semicircular canal function test

Genetic evaluation:

• If bilateral tumor → genetic test for NF2
• If age <30 years → consider screening
• If positive family history

Your Three Treatment Options Explained

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There is no single "correct" treatment for everyone. The decision depends on multiple factors we'll analyze together.

Option 1: OBSERVATION (Watch and Scan)

For whom?

• Small tumors (<1.5 cm)
• Minimal or no symptoms
• Advanced age with comorbidities
• Useful hearing we wish to preserve
• Patient prefers to avoid active treatment

What does it involve?

• Annual MRI to monitor growth
• Audiometry every 6-12 months
• If grows >2mm/year → reevaluate treatment

Important data:

• 50% of small tumors do NOT grow significantly
• Average growth rate: 1-2 mm/year
• It's a VALID option, not "doing nothing"

Option 2: STEREOTACTIC RADIOSURGERY (Gamma Knife / CyberKnife)

For whom?

• Small to medium tumors (<3 cm)
• Patients who prefer to avoid open surgery
• Comorbidities that increase surgical risk
• Tumor in only functioning ear
• Advanced age

What does it involve?

Highly focused radiation that "stops" tumor growth.

• Outpatient procedure
• Single 3-6 hour session (Gamma Knife)
• Or 3-5 sessions (CyberKnife, fractionated radiosurgery)
• Stereotactic frame or mask
• Dose: 12-13 Gy to tumor margin

Results:

• Tumor control: 90-95% at 5 years
• Hearing preservation: 50-70% if hearing is good pre-treatment
• Facial nerve preservation:>95%

Option 3: MICROSURGERY (Surgical resection)

For whom?

• Medium to large tumors (>2.5 cm)
• Rapidly growing tumors
• Significant brainstem compression
• Young patients (<60 years) with medium tumor
• Already very deteriorated hearing
• Patient preference

Surgical approaches:

Approach	Indication	Hearing
Translabyrinthine	Non-useful hearing Any tumor size	Sacrificed
Retrosigmoid	Preserve hearing Any size	Attempted preservation
Middle fossa	Very small intracanalicular tumor Preserve hearing	Greater preservation chance

Modern surgery:

• High-definition microscope
• Intraoperative facial nerve monitoring(CRITICAL)
• Brainstem monitoring
• Neuronavigation(surgical GPS)
• Vascular preservation techniques

Results with experienced surgeon:

• Complete resection: 95-98%
• Anatomical facial nerve preservation:>95%
• Normal facial function (House-Brackmann I-II): 85-95%
• Hearing preservation (if conservative approach): 30-70% depending on size
• Mortality:<0.5% in centers of excellence

Skull Base Surgery: What to Expect

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Before surgery:

Preanesthetic evaluation:

• Complete laboratory tests
• Electrocardiogram
• Anesthesiology evaluation
• Blood reserve (rarely needed)

Preparation:

• Discontinue anticoagulants/antiplatelets 7-10 days before
• Antibacterial shampoo night before
• 8-hour fasting
• Preanesthetic medication

During surgery (4-8 hours):

General anesthesia:

• Endotracheal intubation
• Arterial and central venous lines
• Urinary catheter

Neurophysiological monitoring (MOST IMPORTANT):

• Facial nerve: Continuous electromyography - allows me to "see" the nerve throughout surgery
• Cochlear nerve: Auditory potentials (if attempting hearing preservation)
• Brainstem: Evoked potentials to prevent ischemia

Surgical technique:

1. Positioning: Lateral or semi-sitting depending on approach
2. Incision: Behind ear (retroauricular) or suboccipital
3. Craniotomy: Precise bone opening
4. Dural opening: Access to tumor
5. Debulking: Internal tumor evacuation first
6. Capsular dissection: Careful separation from facial nerve (WITH MONITORING)
7. Hemostasis: Meticulous bleeding control
8. Closure: Dura, muscle, skin in layers

After surgery:

Intensive Care Unit (24-48 hours):

• Close neurological monitoring
• Fluid and intracranial pressure management
• Pain control

Hospitalization (3-7 days):

• Day 1-2: Rest, begin mobilization
• Day 2-3: Drain removal
• Day 3-4: Ambulation with assistance
• Day 5-7: Discharge if stable

Home recovery:

Weeks 1-2:

• Relative rest
• Avoid straining and lifting weight
• Wound care
• Medication: analgesics, preventive anticonvulsants

Weeks 3-6:

• Begin vestibular rehabilitation (if necessary)
• Light exercise allowed
• Gradual return to activities

Months 2-6:

• Complete return to work and normal activities
• Control MRI at 3-6 months
• Audiological evaluation

Management of potential complications:

Facial paresis (if it occurs):

• Majority are temporary(nerve edema)
• Typical recovery: 3-6 months
• Eye care: artificial tears, nighttime patch
• Facial physiotherapy
• If permanent (rare): reconstructive surgery

Post-surgical headache:

• Common first weeks
• Management with analgesics
• Gradual improvement

Imbalance:

• Expected first weeks
• Brain compensation: 3-6 months
• Vestibular rehabilitation accelerates recovery

Why You Need a Specialized Neuro-Otologist

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Acoustic neuroma is not surgery for any general surgeon or ENT. It requires subspecialized training.

What is a neuro-otologist?

• Otolaryngologist with subspecialty in neurotology
• Additional 1-2 years training in ear and skull base surgery
• Expert in temporal bone and cerebellopontine angle anatomy
• Experience in cranial nerve preservation

My specific training:

• Otolaryngology Residency: 4 years (IMSS UMAE 14 Hospital)
• Neurotology Subspecialty: 2 years (National Institute of Neurology and Neurosurgery - INNN)
• Rotations at centers of excellence: Skull base surgery
• Current board certification: Mexican Council of Otolaryngology
• Experience:>50 lateral skull base surgeries

Multidisciplinary team:

Optimal neuroma management requires collaboration:

• Neuro-otologist(me): Primary surgeon
• Neurosurgeon: In complex cases with intracranial extension
• Neurophysiologist: Intraoperative monitoring
• Audiologist: Pre and post-operative evaluation
• Specialized anesthesiologist: Neurosurgery
• Rehabilitation: Vestibular and facial physiotherapy

Technology that makes the difference:

Facial nerve monitoring:

• Continuous electromyography (EMG) throughout surgery
• Alerts me in real time if I approach the nerve
• Allows anatomical and functional preservation
• Result:>95% facial function preserved

Other resources:

• High-definition surgical microscope
• Neuronavigation (in complex cases)
• Lumbar drainage system
• Neurocritical ICU with trained staff

Advantages of Treatment in Tijuana-San Diego

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Access to specialized care:

• Board-certified neuro-otologist with subspecialty
• Neurophysiological monitoring technology
• Hospital with neurocritical ICU
• Same standards as U.S. at lower cost

Cost advantage:

Service	Tijuana	San Diego
Brain MRI with contrast	$300-400 USD	$1,500-3,000 USD
Specialized consultation	$100-150 USD	$350-600 USD
Complete audiometry + ABR	$80-120 USD	$300-500 USD
Neurotology surgery (package)	$15,000-25,000 USD	$80,000-150,000 USD

For San Diego patients:

• Consultations and studies: 15-30 min from border
• Coordination with U.S. physicians: Reports in English
• Flexible follow-up: In-person or telemedicine
• Referral network: If radiosurgery or complementary management needed in U.S.

Comprehensive care:

• Detailed explanation of options (no pressure for surgery)
• Second opinion welcome
• Coordination with other specialists
• Psychological support if needed
• Long-term follow-up

Frequently Asked Questions

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❓ Is acoustic neuroma cancer?

NO. It's a BENIGN tumor that doesn't spread. It's not cancer and will not become cancer.

❓ Can I die from this?

With appropriate treatment, mortality risk is extremely low(<0.5%). Untreated giant tumors can cause serious complications, but this is preventable with timely management.

❓ Do I have to have surgery immediately?

Rarely urgent. Most cases allow time to research options, get second opinion and plan treatment. Only giant tumors with severe brainstem compression require urgent surgery.

❓ Will I have facial paralysis?

With experienced surgeon and nerve monitoring: 85-95% maintain normal facial function. The rest have mild weakness that usually improves. Permanent facial paralysis is rare (<5%).

❓ Will I lose my hearing?

Depends on approach and tumor size:

• Radiosurgery: 50-70% preserves useful hearing
• Retrosigmoid surgery: 30-70% depending on size
• Translabyrinthine surgery: Hearing intentionally sacrificed

We'll discuss the best option for your case.

❓ Radiosurgery or surgery - which is better?

No universal answer. Factors to consider:

• Size:<2.5cm favors radiosurgery, >3cm favors surgery
• Age: Young people (<60) sometimes prefer definitive treatment
• Hearing: If already poor, surgery may be better
• Patient preference

We'll review your specific case together.

❓ Can it grow back after treatment?

• Surgery (complete resection): 2-5% recurrence at 10 years
• Radiosurgery: 5-10% require additional treatment

Follow-up with periodic MRI allows early recurrence detection.

❓ How much recovery time do I need?

• Radiosurgery: 1-2 days, immediate return to activities
• Surgery: 5-7 day hospitalization, return to work 4-6 weeks, complete recovery 3-6 months