14November2018

Andaman Chronicle

The Daily Diary of the Islands

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ACOUSTIC NEUROMA TREATED WITH CYBERKNIFE

Dr. Aditya Gupta

WHAT IS ACOUSTIC NEUROMA

Acoustic Neuroma which is also known as vestibular schwannoma, is a benign tumour which is non cancerous and usually grows slow. It develops on the main nerve that leads from inner ear to brain. The branches of this nerve influence the balance ,hearing and the pressure from an acoustic neuroma that can cause hearing loss, ringing in your ear and unsteadiness.

SYMPTOMS

The symptom starts with the gradual loss of hearing in one ear and the problem is accompanied by the ringing in the ear also with the feeling of fullness in the ear. The acoustic neuromas can cause the sudden hearing loss.

The symptoms that occur over time include :

1. Vertigo. 2. Facial numbness and tingling. 3. Problem with balance. 4.  Facial weakness. 5. Change in taste. 6. Difficulty in swallowing. 7. Headaches. 8. Clumsiness. 9. Mental confusion

Cyberknife radiosurgery has revolutionized the treatment of acoustic neuroma

CAUSES OF ACOUSTIC NEUROMA

The cause of the development of acoustic neuroma is unknown. A rare hereditary disease “Neurofibromatosis" is associated with acoustic neuroma.

Acoustic Neuroma can also be caused by:

• Continuous exposure to loud noise

• Radiation on face and neck can lead to acoustic neuroma many years later.

 In 1 out of 10 people, an acoustic neuroma is caused by neurofibromatosis type 2 (NF2). NF2 can run in further generations also. Person suffering from NF2 can develop benign tumours on the spinal cord and the coverings of the brain.

Acoustic neuromas is formed through type of cells called a Schwann cell. These cells cover the nerve cells of the body. That's why this tumour is also called  vestibular schwannoma.

Acoustic tumour grows with the nerve in the brain. This nerve is called cranial nerves or the acoustic or vestibulocochlear nerve. This nerve is responsible to control the sense of hearing and also the  balance of the body.

Acoustic tumour is rare and in between 1 and 20 people in every million worldwide are diagnosed each year with an acoustic neuroma. And its more common in women than men.

ACOUSTIC NEUROMA TREATED WITH CYBERKNIFE

The survey says that two out of 100,000 people aged 30 to 60 develop acoustic neuroma, which makes this condition incredibly rare.

The Acoustic Neuroma treatment depends on the size of the tumour. If the tumour is large, there will be more medical problems. The small size of the tumour is less than 1.5 cm, medium is between 1.5 cm and 2.5 cm and large is 2.5 cm or larger. Small tumours require cyberknife due to their size while the larger tumours typically require surgery.

The newest radiation therapy option for acoustic neuroma is a form of radio surgery that requires absolutely no incisions using new technology called CyberKnife. Patients treated with this new non-invasive experience minimal to no side effects.

Radio surgery techniques can stop tumours from growing by using high-dose exact precision radiation treatment. Patients treated by CyberKnife® technology experience minimal to no side effects, and receive treatment on an out-patient basis. After patients undergo radio surgery, the acoustic neuroma is closely monitored to confirm the growth has stopped or that the tumour has begun to shrink.

The surgery includes advanced robotics, tumour tracking and imaging capabilities.

The patients with particular symptoms like pressure symptoms, tinnitus, or imbalance may be best treated with this  surgery  because surgery will relieve the symptoms more rapidly. Also the large tumours means the size greater than 3.0 cm are best treated with surgery because these tumours can sometimes swell and cause obstruction in the flow of cerebrospinal fluid.

Treatment starts with the CT scan. The CT scan image is then imported to the CyberKnife Treatment Planning System. The oncologist team make a plan to treat the tumour while avoiding surrounding important sensitive structures.

The process involves several sittings and per sitting lasts for maximum 1 hour per sitting . The treatment does not require any sedation and is painless.

The chances of side effect is next to negligible. Hearing is preserved and achieved in 50-75% of the time. Temporary numbness of one side of face is 2-3%. After the CyberKnife surgery tumours stabilise in size then shrink with time. 

Dr. Aditya Gupta is the Director, Neurosurgery, Agrim Institute for Neuro sciences, Artemis Hospital.

  • Written by Denis Giles
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