About acoustic neuroma
Acoustic neuroma - a well-studied benign tumors of the brain, which attracted the attention of neurosurgeons all generations. They represent about 8 - 10% of all intracranial tumors, and found one person per 100,000 population. Over 95% of them are found on only one side. Hearing loss - the main symptom of this disease.
The growth rate of acoustic neuromas is highly variable and its mean value is 1 - 2 mm per year. There are cases when the tumor grows year by 30 mm. In 6% of patients have a regression of the disease: the tumor shrinks.
Manifestations of acoustic neuroma is so typical and bright, even at the dawn of modern medicine have been described the first cases. One of the first doctors who did was Dr. Sandiford from the Netherlands. In 1776 he represented these tumors, but not as acoustic neuroma, but as "little bodies, hidden in the deep pockets of the brain and cause deafness." Only 50 years later, Dr. Leveque-Lasourie described the clinical picture of acoustic neuroma, a little later, Dr. Cruveilhier presented the first clinical case of the disease in 26-year-old woman.
At the beginning of the last century it was suggested surgical treatment of these tumors.For its implementation was performed to remove the tumor surgeons finger that three of the eight patients resulted in death. This surgical technique is always assumed bleeding, damage to all anatomical structures, particularly the brain stem.
Only to development of a variety of tools began an era of surgery acoustic neuromas.
SYMPTOMS
Although patients with acoustic neuroma talk about a variety of manifestations of his disease, the classic symptoms are considered hearing loss (95% impose such a complaint), tinnitus (70%), abnormal coordination (65%) (see table of complaints of patients).
Patients' complaints | % |
Hearing loss
|
95
|
Tinnitus
|
70
|
Incoordination
|
60
|
Headache
|
32
|
Facial numbness
|
29
|
Facial weakness
|
10
|
Double objects before the eyes
|
10
|
Nausea, vomiting
|
9
|
Earache
|
9
|
Change of taste
|
6
|
In contrast to the patient's complaints, the clinical manifestations of the disease, revealed by examination doctor, are not common to all patients. The most common among them: changing the corneal (corneal) reflection (35%), nystagmus (25%), and hypoesthesia on the face (25%) (see table of symptoms).
Symptoms of the disease | % |
Changing the corneal reflex
|
35
|
Nystagmus
|
25
|
Facial hypoesthesia
|
25
|
Weakness of the facial muscles
|
12
|
Eyeball movement disorder
|
11
|
Swelling of the fundus
|
10
|
Babinski
|
5
|
Submitted complaints and symptoms may occur both independently and in combination with each other.
Widespread use of modern neuroimaging techniques (eg, magnetic resonance imaging) increased the number of detections of small acoustic neuromas, which are manifested by one or two complaints and the same number of symptoms. Therefore, all patients who have listed complaints must be examined by a neurologist. But at any stage of the disease acoustic neuroma causes at least one otologic symptoms (symptom from the auditory analyzer - hearing loss, noise or ringing in the ear). Therefore, all patients complained of unilateral hearing loss should be examined by a otonevrologa or otolaryngologist, including audiometry, and they need to make MRIS head.
DIAGNOSIS
All patients with acoustic neuroma study tested head on magnetic resonance imaging (MRI) in different projections - axial, frontal, sagittal (Figure 1).
HOW TO TREAT?
There are several options for the management of patients with acoustic neuroma. The choice of treatment is determined individually in each case and depends, as it does not sound strange, the preference of the doctor and the patient. This is due to a large variety of manifestations of the disease, ie manifestations acoustic neuromas.
Each method, there are many followers, and the doctor, not having a clear idea about the benefits of each of them, the choice seems to be rather difficult. Nevertheless, the patient, of course, must make their own informed decision, and the doctor's recommendation, to which it is addressed, are often quite strong motivation. In light of the above, we note that the surgeon's preference based on his personal experience, should not interfere with evidence and science-based approach to treating patients.Arguments in favor of a particular method allow a comparison of methods and make an informed decision, defining the ultimate goals of treatment. Suppose it can not determine the best choice, however, it will help identify patients.
To exclude the subjective factor when choosing a method of treatment proposed many schemes and algorithms. But always alone or in combination using 3 methods of treatment.
Monitoring of patients with regular clinical and radiographic control. Since the advent of magnetic resonance imaging (MRI), this method is used more often, and almost always in the primary detection of small neuromas.
Operation becomes more reliable, and therefore more affordable and common treatment.During surgery are used constantly improving surgical and anesthetic techniques, including microscope and intraoperative neurophysiological monitoring. Most patients with acoustic neuroma using this method, but its choice, especially in the early stages of the disease is not automatic.
RR represent treatment using external light sources. When stereotactic radiosurgery radiation dose to the tumor fed single faction. Stereotactic techniques are used to summarize the dose accurately according to the shape and location of the tumor and carried out either on the "Gamma Knife" or a linear accelerator. When radiotherapy radiation is supplied by several factions. Guidance as produced using a stereotaxis, and three-dimensional coordinate system. Of all the methods of fractionated radiation used last.
The main criteria for selection of patients are tumor size, patient age and comorbidities.
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