Researchers at University of California San Diego School of Medicine found that using an innovative surgical approach to remove an acoustic neuroma, a slow-growing, benign brain tumor, improved hearing preservation and quality of life for patients while also presenting excellent facial nerve outcomes.
The results, published in the May 21, 2024 online edition of Otology & Neurotology, showed that surgically removing an acoustic neuroma by exposing the area above the inner ear and the internal auditory canal significantly improved hearing preservation and quality of life, along with balance, anxiety, energy, pain and general health in patients at the one-year post-surgery mark.
More specifically, hearing was preserved in 68% of patients, while 94% of patients showed excellent facial nerve outcomes at post-operative follow-up.
"We have found that patients with an acoustic neuroma could experience symptoms that significantly impact their overall physical and mental well-being," said Rick Friedman, MD, PhD, professor in the Department of Surgery at UC San Diego School of Medicine and neurotologist at UC San Diego Health. "There has been a definite benefit to surgery when we were able to save a patient's hearing, which can directly affect their quality of life, instead of taking the conservative approach and waiting to operate until after they've already lost their hearing."
The middle fossa craniotomy approach is used to treat smaller tumors, up to about 1.7 centimeters in length, generally confined to the internal auditory canal. It involves a skilled specialist looking down at the floor of their cranial cavity and making an incision above the ear. They then carefully expose and dissect the tumor, without compromising the surrounding structures of the brain or inner ear to preserve hearing.
An acoustic neuroma, also referred to as a vestibular schwannoma, is a tumor that can grow on the nerve that connects the ear to the brain. Schwann cells wrap around nerve fibers to help support and insulate them, including hearing and balance nerves inside the ear. Overproduction of these cells, however, can cause tinnitus (ringing in the ear), hearing loss, dizziness, and loss of balance. If left untreated, the tumor can grow and place pressure on the nerve and nearby brain structures and become life threatening.
Very few acoustic neuroma centers in the nation offer middle fossa surgery.
The study, which involved 71 participants, is the first time quality of life has been measured after acoustic neuroma removal using this innovative surgical approach.
"Many patients attribute one-sided hearing loss to aging and don't realize that a simple MRI scan can present answers to their discomfort," said Friedman. "We want them to live as full of a life as possible after the tumor is removed and preserve their hearing. This study is important for us to understand patient motivation for surgery, patient counseling and management of their expectations."
Patients like Julie Sifford, a Las Vegas resident, deeply understand the desire for greater relief from symptoms caused by a small tumor. In early 2023, she experienced the effects of an acoustic neuroma firsthand.
After Sifford became severely ill — feeling numbness in her limbs, memory loss, and tinnitus — her local health care provider recommended she have an MRI. The results revealed she had an acoustic neuroma.
"It's never easy to learn that you have been diagnosed with a brain tumor, it's the unknown that's scary," said Sifford.
Following her extensive research to ensure she was in the hands of qualified surgeons, Sifford was referred to the acoustic neuroma program at UC San Diego Health where world-renowned specialists Friedman and Marc Schwartz, MD, co-director of the program and neurosurgeon at UC San Diego Health, evaluated her and made recommendations on how best to proceed with treatment.
Recognized as an Acoustic Neuroma Association Center of Excellence, the international, multidisciplinary program at UC San Diego Health is skilled in newer techniques, including the middle fossa craniotomy. They are the highest-volume acoustic neuroma center in the nation by a significant margin, averaging 160 surgeries annually.
"Patients are happy with our care and proactive management of their tumors as one of the few institutions in the country that are capable of doing this procedure," said Schwartz, professor of neurological surgery at UC San Diego School of Medicine.
"Like Julie, we consult with more than 400 people annually by phone or virtually, and more than 40% of surgical patients travel from around the globe to our center for superior outcomes."
Not long after transferring care to UC San Diego Health, Sifford, accompanied by her husband and 8-year-old daughter, flew to San Diego for an in-person consultation with Friedman and Schwartz.
"They were both very kind, experienced and attentively involved my family throughout the process," Sifford said. "Their confidence gave me confidence."
Sifford added she did not want to subject herself to possible future complications for the rest of her life. Leaning toward the middle fossa craniotomy and considering the collective information she received from both doctors, Sifford, who was not part of the study cohort, made the informed decision to have surgery.
Surgical removal of the tumor carries a significant risk of total hearing loss due to the shared blood supply between the tumor and the nerve — something Sifford braced for.
"That's the risk I'm willing to take to not have this growing tumor," said Sifford.
That summer, Sifford had surgery and was discharged just two days after the successful operation.
"They were so thoughtful with how they conducted my surgery," Sifford said with appreciation. "Dr. Friedman took my hair in the front, braided, and cut around it. After I left the hospital, you could not even tell that I just had brain surgery."
"Purposely for women, I found that shaving only a small portion of their hair added no greater risk and made them feel human," Friedman said.
Sifford is back to working full-time, exercising, and even took a cross-country trip with her family.
"From the doctors and nurses to the cleaning and nutrition staff — they all made a profound difference in my care," Sifford said. "They were an incredible group of kind and compassionate professionals from the start of my care to recovery and follow-up. They added a personal touch across the board."
The study, adds Friedman, has a greater emphasis placed on patient-centered care and shared decision-making between physicians and patients.
"With the results from this study, we can further advance treatment options for patients with an acoustic neuroma and continue to deliver exceptional, leading-edge care to more individuals around the world," Friedman said.
Co-authors of the study include: Pawina Jiramongkolchai, Alexandra Vacaru, Olivia La Monte and Joshua Lee, all at UC San Diego.
The funding for this research came, in part, from UC San Diego Health.
