People suffering from a neural (cranial) tumour located in the brain — acoustic neuroma, nowadays can receive several efficient treatment possibilities. Choice of the right treatment method depends on each particular situation. In order to prescribe the most efficient and safest treatment method for you, our specialists have to assess the stage and spread of the disease, the level of aggressiveness of tumour, previous health examinations and treatment.
Radiosurgery Centre Sigulda offers acoustic neuroma (neurinoma) treatment with the last generation robot CyberKnifeⓇ M6. Acoustic neuroma is treated with radiosurgery method without surgical intervention, anaesthesia and blood loss.
Treatment of tumours in head with CyberKnife® M6 Step by step
How can we help if you are diagnosed with acoustic neuroma?
After establishment of the Radiosurgery Centre Sigulda (2015) our clinic offers the world's most advanced non-invasive acoustic neuroma treatment with the Cyberknife® M6 robotic radiation delivery system:
- CyberKnife® M6 radiosurgery ensures 98% of growth control of a tumour as well as minimal side effects;
- Our team consists of experienced, highly qualified specialists (otolaryngologist, neurosurgeon, neuro radiologist, radiation oncologist) specialising in diagnosing and treating of acoustic neuromas;
- Each individual case is assessed by the specialist team — within the framework of the board of specialised doctors;
- The most advanced methods for diagnosing acoustic neuroma, for example (video head impulse test (VHIT)), 3 Tesla MRI scan, 64 slice CT scan, are available to our patients;
- Our specialists have deep knowledge of conventional treatment methods for acoustic neuroma and have gathered more than twenty years of experience in treatment;
- Our specialists work according to the guidelines of the professional associations on the basis of recent clinical trials and experience of the leading European clinics, in line with especially elaborated protocol for acoustic neuroma treatment;
- Results of treatment efficiency of patients during two years’ period completely correspond to the results of the leading CyberKnife centres in Europe both in terms of efficiency and safety;
- The main task of our specialists is to offer diagnostics and treatment method that is most suitable for you.
Ask here and our specialists will help you to understand your situation and find the best solution in your case.
Treatment of acoustic neuroma with CyberKnife — 2 years before and after
Acoustic neuroma treatment methods
Historically there have been three treatment options for acoustic neuroma:
- Radiation therapy or radiosurgery;
- Regular surveillance.
Tumours less than 5 mm in size rarely have prominent side effects therefore usually in such cases surveillance and MRI scan is recommended every 6 months.
If acoustic neuroma continues growing and reaches 10-20 mm in diameter or a patient has prominent complaints about a tumour of a smaller size, the best option is radiosurgery, allowing delivery of higher radiation dose to the tumour with a minimum impact on the surrounding nerves and brain tissue.
Radiosurgery is often applied in case of recurrent acoustic neuroma and where tumour tissues remain after a surgery and it is impossible to remove the tumour completely.
Goal of the radiosurgery is to stop acoustic neuroma from growing. Rather frequently, within 2 years after the radiosurgery, one can detect also reduction in tumour mass by 20-25%, in comparison to the condition before the manipulation. Regardless of efficiency of the method and accuracy of radiation delivery from different radiosurgery equipment, both results and also side effects may vary after the procedure. Major shortcoming of the method — tumour shrinks gradually and over a longer period (1-3 years) after the therapy, and hence complaints caused by the tumour also reduce gradually, over months or even years.
The most common side effects after the procedure are:
- Facial nerve and trigeminal nerve weakness or neuropathy;
- Ringing in ears;
- Vertigo and balance disorders.
In order to achieve ultimate effect and to reduce tumour size and also side effects caused by the radiosurgery to an extent possible, it is important to use the most advanced diagnostic examinations to prepare the planning of the radiosurgery: 3 Tesla magnetic resonance imaging and at least 64 slice computed tomography scan, ensuring radiation to a precision of a millimetre.
Optional method — neurosurgery or microsurgery is routinely chosen due to the size of a tumour, if:
- It presses on the brainstem;
- It has prominent mass effect;
- Tumour structure is cystic or contains liquid;
- And/or there are complaints about aggravating condition becoming unbearable.
Compared to neurosurgeries performed in the beginning of the last century, patient mortality from such manipulations have decreased from 73% to 0.5%, however one must bear in mind that the surgery can still lead to relatively severe side effects:
- Complete hearing loss in the operated side;
- Damage to the facial nerve leading to deformation or drooping of one side of the face;
- In milder cases facial numbness can occur and it tends to disappear in 80% of cases during a course of 1 year;
- Permanent headache;
- In 5% of cases tumour recurrence is observed, especially if the tumour has grown into bone structures and it cannot be evacuated completely without causing a defect;
- Accumulation of cerebrospinal fluid in the operated area, meningitis, cerebrospinal fluid reflux disorders are possible as post-operative side effects.
Advantages of treatment with CyberKnife
Robotic radiosurgery with the CyberKnife M6 system is efficient and safe method based on clinical trials — known for more than 15 years.
Expected therapeutic results are based on quantitative clinical research and qualitative clinical research; efficiency is proven in patient surveillance for more than 15 years;
In 97% of cases where acoustic neuroma is treated with CyberKnife, a tumour is expected to stop growing or reduce in size by 20-25% over next 2 years after the treatment;
Using CyberKnife to treat small and medium acoustic neuromas, no prolonged recovery and rehabilitation is required after the therapy, side effects tend to not be more severe than those triggered by the tumour and can be controlled with appropriate medical treatment.
Acoustic neuroma growth is stopped without surgical interference, without pain, without a need for rehabilitation, at a precision of a millimetre, ultimate prevention of a human mistake and minimum risk of side effects.
Maximum dose of radiation is delivered directly to the tumour from many different angles with sub-millimetre precision, allowing linear accelerator of the radiosurgery system CyberKnife® M6 to target the affected tissue while minimising exposure to nearby tissues.
A patient may lay and breathe freely during the robotic radiosurgery. The device spots even the slightest patient movements and adjusts accordingly. For safety reasons the patient has a light thermoplastic mask during the procedure, and usually it does not cause unpleasant sensations and claustrophobia. Unlike other radiosurgery methods, such as Gammaknife, a patient does not require a stereotactic frame or tight fixation mask, commonly used in other radiosurgery systems.
If acoustic neuroma has been detected where it already has serious side effects, robotic radiosurgery can be combined with microsurgery thus reducing mass effect on other parts of the brain;
If there is a risk of recurrence after previous surgery or it was not possible to remove the tumour entirely, the remaining tissue can be treated with CyberKnife.
Majority of our patients, two years after the radiosurgery with CyberKnife, no longer feel the symptoms of disease and are satisfied with their choice.
Radiosurgery with CyberKnife makes patients feel better, because it treats the tumour in a comfortable and efficient way, not affecting the quality of life.
Radiosurgery with CyberKnife is a treatment on out-patient basis. After the procedure you can go home the same day and no hospital stay is required.
Unpredictability of real costs related to the disease can actually make your budget vulnerable:
- If you need a diagnosis you might have to wait in a long queue for another MRI scan and be left wondering about what does the opinion says;
- A neurosurgery can be related to hardly predictable post-operative care and rehabilitation costs, which are not routinely covered from the state budget,
- Unclear picture of doctor's fee.
These are issues raising the stress level and leading to anxiety in already complicated period of disease.
We have tried to elaborate our service price list to make costs of diagnostics and therapy transparent and predictable.
However, if you have any question about possible costs, please ask our customer consultants.
View our service price list.
Treatment of tumours in head with CyberKnife
In order to evaluate efficiency for treatment of tumours in head with the CyberKnife system, it is possible to take individual free of charge on-line patient consultation where data from medical history are assessed.
In order to apply for a on-line consultation, please send data from on-line contact form or data uploading form here.
Data necessary to initially assess treatment options:
• Magnetic resonance imaging (MRI) with a description or access code to the scan in a data base or images of the scan in DICOM format, recorded in CD, or uploaded in data uploading system at the hospital's website (preferably not older than 4 weeks).
Onsite consultation in the Centre.
Possible therapy tactics, side effects and course of the therapy are explained in a consultation. Image data from previous analyses and diagnostic radiology are demonstrated and explained.
The Medical Treatment Law stipulates that treatment tactics of each patient is examined in a multidisciplinary tumour board consisting of a neurosurgeon, radiation oncologist and radiologist. The treating doctor presents patient's medical data to the members of tumour board. If necessary, the patient is invited to attend the tumour board in person to directly discuss different aspects of treatment with the tumour board members.
Brain tumour – acoustic neuroma
There are over 40 types of tumours localised in the brain or bone structures of the skull, however, they are basically divided into two groups:
- Benign cranial tumours;
- Malignant cranial tumours.
Metastases in brain is a separate group of tumours localised elsewhere. Metastases most commonly occur from primary tumours such as breast, lung and intestinal cancer as well as renal cancer and melanoma.
Benign tumours grow slowly and rarely spread outside the borders of tissues from which they form. Most frequently occurring benign tumours are meningiomas (tumours in the meninges), acoustic neuromas (schwannoma of acoustic nerve) and pituitary adenomas (benign tumours stemming from gland tissues).
Malignant brain tumours are called brain cancer or glial tumours (gliomas). Unlike benign tumours, the malignant ones grow into or infiltrate the structures of other tissues and can spread to other parts of the brain or spinal cord.
The most common tumours are astrocytomas, oligodendrogliomas, glioblastomas and gliomas with combined structure.
Acoustic nerve neuroma is a slowly growing, benign skull base tumour, forming from acoustic or vestibulocochlear nerve sheath. Tissues of the acoustic nerve are called Schwann cells, hence a neuroma has a medical term — vestibular schwannoma. Neuroma basically damages the acoustic nerve in section between the inner ear and the brain and influences the function of acoustic and vestibular system.
Acoustic neuroma is a benign tumour and it does not invade the structures of other tissues and has no metastases. Majority of patients are diagnosed with a neuroma in one side of the head, however, in approximately 6% of patients experience acoustic neuroma in both sides of the head during their lifetime. Most frequently such situation is established in case of neurofibromatosis (inborn genetic disorder).
Acoustic neuroma — a tumour of vestibulocochlear nerve sheath
Diagnosed in ages between 45 and 80+, most frequently at 50 years of age;
Detected in 1 person out of 100 thousand on average;
6% of all primary tumours in head;
After a neurosurgery of acoustic neuroma:
- 0.5% post-operative mortality;
- In 25% of cases — facial nerve complications;
- In 26% of cases — other post-operative complications;
- Repeated growing of acoustic neuroma over 3-4 years;
- There are patients who had even 3-4 brain surgeries during their lifetime.
Disease symptoms depend on size of the tumour and position on the nerve. Most frequent symptoms:
- Impaired hearing or rapid hearing loss, which is usually the first symptom due to which patients visit otolaryngologist (ear specialist);
- In approximately 80% of cases patients hear different noises — hissing, ringing or buzzing;
- Vertigo that may cause balance disorders or sickness is reported frequently;
- Sometimes patients complain about headaches, especially in morning after waking up as well as during coughing;
If a neuroma has grown big enough, it touches and compresses also other facial nerves;
- Patient may complain about tingling or even numbness in one side of the face and also visual changes can be noticed, such as drooping eyelid or mouth corner;
- In some cases one can establish also temporary vision impairment or difficulty swallowing related to compression of certain nerves;
- If the brainstem is compressed due to tumour's size, the headache resulting from the mass effect and increase of intracranial pressure may become unbearable and lead to severe vomiting and disorientation.
Acoustic neuromas are most commonly detected where patients complain about quickly progressing hear loss, vertigo or headaches. A person is more liable to have this disease if any of his or her family members, parents and grandparents had acoustic neuroma or neurofibromatosis.
If a magnetic resonance imaging scan is performed properly, it is possible to detect tumour of 1-2 mm in size, however most commonly tumours exceeding 5 mm in diameter are found.
Patient may be referred to other examinations within the framework of diagnostics.
- Assessment of hearing function — audiogram;
- Assessment of vestibular system — vestibulogram; or
- Combined assessment (video head impulse test or VHIT)
Igors Aksiks. Acoustic neurinoma. http://www.neurosurgeon.lv/?p=126
Presentation: Dana Mičule. Vestibulokohleārā nerva neirinoma. RSU Otorinolaringoloģijas zinātniskais pulciņš. https://www.slideshare.net/AliseAdovia/vestibulokohler-nerva-neirinoma?qid=0f25a453-7d59-4985-8607-9b12abb064a4&v=&b=&from_search=1