Acoustic neuroma instructions
Acoustic neuroma
This is a benign growth on the hearing nerve inside the head. 'Benign' means that the growth is not a form of cancer and does not spread anywhere else in the body. It only grows on the nerve and pushes the adjacent nerve tissue aside. This tumour generally grows very slowly over a period of years, so the onset of symptoms is slow.
Surgery
This is one of the treatment options that you, in coordination with your doctors, have decided to have for this tumour.
Surgery is usually carried out as a joint procedure between a neurosurgeon and an ENT (ear, nose and throat) surgeon. The operation requires a cut behind the ear on the head and removal of some bone to allow access. This bone removal is an essential part of the operation to see the tumour. It needs meticulous attention to the shape of the brain, blood vessels and tumour itself. These factors are different in each individual, and this part of operation may take up to 4 hours to complete. The brain tissue is then gently retracted aside, and using a microscope, the tumour is removed. These tumours are usually stuck to the nerve responsible for face movement. This nerve becomes thinned out while stretching over the surface of the tumour. Therefore, one of the difficulties in surgery is to separate this "face nerve" from the tumour. Most patients develop a temporary loss of movement in that side of the face due to the surgeon manipulating the nerve. Usually this gets better over weeks or months after the operation, but in some patients it may take over a year. Sometimes the nerve gets permanently injured and never recovers. For this situation, we may need to do additional surgery many months later to partially help the face weakness.
Depending on the size of the tumour, other nerves or parts of brain tissue need to be separated from the tumour. In rare cases, removing these surrounding structures can result in permanent damage. Fortunately, this is uncommon, and the operation has very low mortality (1%).
Because the hearing nerve is always part of the tumour, there will be no hearing left on the operated side, after the tumour has been removed.
After removing bone and tumour, the remaining hole created during the operation will be patched with fat taken from under the skin in the abdomen. Sometimes this patch is not sealed completely and clear fluid can leak after surgery from the surgical cut or even from the nose, as this organ is connected to the ear.
Before surgery (pre-admission clinic)
Your doctor's office will book a date for you to come to the hospital for a pre-admission visit. At this visit, a nurse will ask you about your health and help prepare you for surgery. You may have many tests done such as: blood work, ECG and chest x-ray. Other tests and assessments by specialty doctors (such as an anaesthetist) may be required.
You will be given information at your pre-admission visit about where to go on the day of your surgery, what to bring with you to the hospital, and how to prepare at home the night before.
After surgery
After surgery, a bulky dressing will be applied on the small incision. You should leave this secured in place for 2-3 days following surgery. Most patients experience some degree of headache, nausea, vomiting and sleepiness after surgery. This may last for a few days and is different depending on each individual and the size of tumour. This operation is not very painful and immediate pain is controlled with painkillers.
Most patients start getting out of bed next day after surgery and usually become mobile independently by two to three days. With larger tumours, recovery may take longer especially if there are complications (although these are uncommon).
Because the facial nerve (the nerve that moves the facial muscles) is often weak for a period of time after surgery, special care has to be taken. The eyelid on that side may be unable to close, and there is a risk that the eye can be exposed too much to the air, and it can be become dry and even ulcerated. To avoid this, special artificial tear drops need to be put in the eye every 2-4 hours and special moisturizing ointment applied to the eye at nighttime. This treatment with eye drops may need to continue for many weeks (rarely months) until the eye closure becomes normal. Occasionally, these steps are not enough to protect the eye, and we need to ask an eye specialist to temporarily close the corner of eyelids to make the eye opening smaller.
This helps to keep moisture over the eye and prevents dryness. Rarely, when the face is completely weak, a small piece of gold weight (about 1 gram) will be put under the eyelid skin with small surgery to help the eye closure with gravity.
Occasionally, the clear brain fluid that surrounds the brain (cerebro-spinal fluid) finds its way out either through the wound or into spaces around ear bone into the back of the throat. The fluid can leak out down the nose. This usually responds to either putting more skin stitches or insertion of a fine tube in the lower spine (called lumbar drain) to reduce the pressure of this fluid and helps to stop the leakage. Rarely, the leak continues, especially if coming from the nose, and we need to re-open and re-seal the surgical space. However, this is in the bone and much simpler than the original surgery.
You may notice a temporary change in your sense of taste following surgery. This is because the face nerve also supplies the sense of taste from the tongue and may be disturbed during surgery.
You may wash your hair while in hospital starting 3 days after surgery, as long as the wound is healing well.
The length of hospital stay varies according to how long or difficult an operation was. In the case of a small tumour, it may be as short as five days, or if complications occur, it will be until the patient is well enough to go home. You will be able to go home as soon as the doctors, nurses, and physiotherapists are happy with your progress.
Medications
When you return home, you may continue to take your own medications unless your doctor tells you otherwise. You will likely have some pain/discomfort at the site of operation and mild swelling and redness around the incision at least for 1-2 weeks. After all surgeries, inflammation is a natural process of healing. With each day that passes, you should get stronger as the healing process begins.
You will be given a prescription for pain medication, usually narcotic pain medication, before you leave the hospital. Follow what the pharmacist tells you (and instructions on the label) when you pick up your medication. Your prescription is usually for 10-14 day supply. It is common to have constipation and slow bowel movement due to the effect of narcotic medication. It is important to drink lots of liquid and ingest lots of vegetables and fruits and maintain good mobility to minimize this condition. If you continue to have significant constipation, you may ask your family doctor for stool softener after 1-2 weeks while on narcotics.
In case of residual face weakness, you will be given prescription for eye drops and ointment to keep the eye moist until your next appointment.
Follow-up appointment
Unless otherwise indicated at the time of discharge, your first post-operative appointment will be approximately 14 days following the date of surgery with the ENT specialist and 6-8 weeks with the neurosurgeon. Your stitches or staples will be removed about 14 days after surgery when you return to the ENT clinic.
Return to work
This may be different depending on many factors, including the degree of symptoms prior to surgery, surgery itself, the patient's body response to surgery and the type of work. Generally speaking, most patients can return to work about 6-8 weeks after surgery. This should occur in a graded fashion and with gradually increasing hours as per the patient's tolerance. This is no rigid rule or recommendation for working after this timeline.
Remember:
Call our office at 416-480-5263 if you:
- Have a large amount of continuous drainage, bleeding, and/or odor from your wound
- Have increased redness/swelling at the incision site associated with unexplained increasing incisional pain
- Have persistent fever greater than 38.5 degrees Celsius (101.3 degrees Fahrenheit) with sweats or chills
- Have increasing eye redness
- Have new or unfamiliar weakness or numbness in your body
