Acoustic Neuroma Recurrence
after surgery

(indented text by AN patients; italics ours)


Many patients believe that surgery gets rid of their AN for good. Unfortunately, this is not so:

(by Debie Aniol)
I wish that there was some way to really impress on everyone who is diagnosed with this tumor that surgery is not a cure! One of the main concerns of probably 95% of all in attendance at the 1999 national ANA symposium was recurrence of the tumor!

The most common cause of AN recurrence after surgery is from incomplete tumor removal, when some of the tumor had to be left behind.  This usually happens unplanned, and depends on what happens during surgery.  Here is a quote from The House Ear Institute's booklet "A Discussion of Acoustic Neuromas," dated 6/95:

Partial removal of the tumor, regardless of its size, may be necessary if the patient's responses during surgery indicate disturbance of the vital brain centers that control respiration, blood pressure, or heart function. If signs of vital brain center disturbance develop during surgery, it is sometimes necessary to terminate the operation before the tumor can be totally removed.

There is also well reasoned article on "The Role of Incomplete Resection" at the UCSF web site:

http://itsa.ucsf.edu/~rkj/Chapter/IncompRes.html

It lists several medical reasons for incomplete removal, and cites a University of Michigan study that 17% AN surgeries involved incomplete removal. The article states that this number conforms to the UCSF experience with AN surgery.  (Note that those doctors who publish tend to be the better ones, and the overall rate of partial removal is higher than for these published studies).

May 1997 issue of ANA's newsletter also has a good piece on AN recurrence. They report that about 25-50% of those with incomplete removal eventually require re-operation. Overall, that's 5-10% of all AN surgery patients!  And here is something else reported in the May 1997 issue of ANA's newsletter:

2-3% of tumors believed to be completely removed end up regrowing as well.

"Believed" is an operative word here. Small amounts of tumor tissue, enough to trigger regrowth, can be left unnoticed by the doctor.  In other cases, this is known but not reported to the patient:

I have learned that just because the doctors say there is total tumor removal that may not be the case. In my situation, at the House Clinic, the doctors told me they totally removed the tumor. Then, I had the operative reports sent to me from the hospital. Yes, they did remove the total tumor, but... they had to leave a very small portion of the tumor capsule, which was attached to my brain stem. So I called the neurosurgeon and asked him what why they told me they removed the tumor in total... he got very defensive.

Just as after radiosurgery, MRIs are needed after surgery, due to an ever-present chance of a recurrence:

I did some further checking on the question of frequency of MRI follow up ... the standard policy of the Clinic is either 5 year or 10 year follow up MRIs, with 5 year perhaps being more the norm.

Last Edited: Friday, November 01, 2002