Outcome and Quality of Life

Acoustic neuroma can be cured by complete tumor resection via the suboccipital approach, and the patients will be able to return to their previous quality of life in most cases.

Facial nerve function is regarded as the most important outcome criterion by all patients. Some patients who show good recovery will nonetheless suffer from side effects such as synkinesia and aberrant innervation of tear secretion. Synk-inesia can be treated successfully with specialized physiotherapy or with muscular injection of botulinum toxin at 4-month intervals.

The postoperative recovery period is highly variable. Based on a recovery recommended for 2 to 3 months, some patients feel eager and fit to take up their profession after as little as 4 to 6 weeks, whereas others continue to suffer from certain sequels, such as head and neck pains, tinnitus induced or worsened by noises and voices, dizziness, and general fatigue, for 6 months or even longer.

On close examination, head and neck pain are found to originate from occipital nerve irritation (rare) or preexisting cervical osteochondrosis. Tinnitus is less common in patients with some preserved hearing, whereas it is increased or more irritating to patients with postsurgical deafness. Balance disturbances resulting from the unilateral loss of vestibular nerve function (because of resection of its tumorous part) may persist in many patients when they are in the dark or have their eyes closed. The 10% of patients with partial preservation of vestibular function show a prolonged recovery course of their balance, possibly resulting from the increasing recuperating nerve function. Although this can be demonstrated clinically

(by caloric, nystagmus, and Unterberger tests), this development may take 1 to 2 years with a very good final result.

Within a rather short period of medical history, the fate of patients with acoustic neuroma has changed dramatically, from suffering a life-threatening disease to a situation where cure and good quality of life are realistic goals.

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