Acoustic Neuroma & Skull Base Procedures

Treatment of skull based tumors can be challenging due to the delicate nerves and blood vessels near the brain. Indiana University Health skull base surgeons have extensive experience with craniofacial, skull-base surgical and microsurgical techniques, including using advanced neuro-imaging tools to successfully treat patients with deep-seated tumors and vascular lesions.

Our highly skilled team includes research specialists at Indiana University School of Medicine, radiation oncologists, neurosurgeons, neuropathologists and neuropsychologists. We ensure patients receive the most innovative, comprehensive treatment from the nation's most experienced tumor specialists and a customized treatment plan for each unique medical condition.

Indiana University Health provides a variety of treatment options for skull based surgery and conditions.

Skull base tumor

Skull based tumors are tumors inside the skull or skull base outside of the brain.  These tumors can compress the brain, brainstem or cranial nerves.  Tumor types often include acoustic neuromas, meningiomas, pituitary adenomas, and paragangliomas.  Our skull base surgeons also treat non-tumor conditions, such as spontaneous cerebrospinal fluid (CSF) leaks.

Symptoms may include a variety of indicators often associated with the region of the skull base, nerve collections or bone formations associated with each compartment. Aggressive surgical treatment at Indiana University Health focuses on treatment options based on the area of tumor: inside the anterior, middle and posterior compartments of the skull base.

Treatment often depends upon the type of tumor, the age and health of the patient, and the tumor size. The experts at Indiana University will formulate a patient-centered, individualized treatment plan best suited for each condition.

Acoustic Neuroma (Vestibular Schwannoma)

An acoustic neuroma is a benign tumor that has the potential to affect a patient’s balance and hearing nerves. Acoustic neuroma tumors most often occur on one side of the patient’s brain, tend to be slow growing and do not metastasize to other portions of the body. On average, over 5,000 acoustic neuroma tumors are diagnosed in the United States each year.

The most common symptoms include decreased hearing and ringing sound in the ear called tinnitus. Other symptoms may include loss of balance, facial numbness or tingling, and in rare cases of very large tumors, confusion and headaches.

Treatment options depend upon the patient age and tumor size. Some tumors can be observed over a span of time to determine the tumor growth pattern. Hearing preservation surgery can lead to favorable long-term outcomes in patients with smaller tumors. Large tumors that compress the brainstem are often surgically removed. Preserving the facial nerve function is a top priority during surgical removal of acoustic neuromas with postoperative function being very favorable when the tumor is small.

Large Acoustic Clinical Trial: Indiana University is part of a national clinical trial for large acoustic neuromas (those larger than 2.5 cm).

As tumor growth increases and interferes with patient quality of life, you can feel safe knowing your Indiana University Health neurotologist and neurosurgeon will consider every option when choosing a surgical approach to patient therapy.

Meningioma

A meningioma is a benign tumor that often originates from the coverings of the brain and spinal cord. These coverings, called meninges, are thin layers of tissue where tumors may be found near the top, curve and base of the brain. Meningioma tumors are typically slow growing, but can cause pressure on areas of the brain or brainstem and interfere with normal functions of the brain.

Meningiomas cause symptoms related to their location near cranial nerves and parts of the brain. Skull base meningiomas can cause hearing loss, swallowing difficulty or visual disturbances. Meningioma tumors are often twice as likely to occur in women as men.

Treatment depends on the location and size of the tumor in addition to the patient’s age and health.  Observation, radiation therapy and surgery are all options at Indiana University Health for treatment of meningioma tumors. 

Pituitary Adenoma

A pituitary adenoma is a benign tumor often found behind the eyes and beneath the brain in the pituitary gland. Pituitary adenoma tumors can affect how the pituitary gland secretes hormones that help regulate metabolism, tissue development, mood and sleep. Some tumors increase hormone secretion while others are ‘non-functional’ or non-secreting.

Symptoms can include infertility or low testosterone levels, diminished libido, high blood sugars and gigantism from excessive secretion of growth hormone. When pituitary adenomas increase in size, they can compress the vision nerves leading to decreased peripheral vision. Other symptoms are often related to hormones secreted such as weight gain, loss of menstrual cycles in females, enlarged feet and hands.

Treatment options at Indiana University Health include hormone testing and imaging studies to review the tumor size and distance from the pituitary gland. Endoscopic pituitary surgery is a common option for treatment of pituitary adenoma tumors, while radiation therapy is an option for patients who may not be a candidate for surgery.

Spontaneous Cerebrospinal Fluid Leak

A spontaneous cerebrospinal fluid leak (or CSF leak) occurs when the fluid surrounding the brain leaks into the nose or ear through a hole in the dura or skull base bone. Spontaneous means the patient has not had an injury that could contribute to the leaking of CSF. 

Symptoms often include copious drainage of clear fluid from the ear or nose. Often patients note there is a large wet spot on their pillow at night.  Some patients may present symptoms of meningitis (fever, nausea, headaches, lethargy) as the first sign of a CSF leak.

Treatment options at Indiana University Health typically involves surgical repair of the CSF leak. Typically, endoscopic repair through the nose is performed for anterior leaks and craniotomy with repair of the skull base is performed for lateral leaks over the ear.

Neurofibromatosis Type 2

Neurofibromatosis type 2 (NF2) is a genetic disorder that affects the development of tissue in or around the nervous system. The most common tumors are vestibular schwannomas on both sides and meningiomas. Tumors along the spinal cord can also occur.

The most common symptoms include hearing loss, balance changes, dizziness or difficulties in walking, or weakness. Other symptoms or signs include glaucoma and vision changes.

Patients can present in their teen years with multiple tumors. Some patients present at older ages with less severe disease.

Treatment of NF2 patients requires a multidisciplinary team and patient-centered approach to care. At IU Health our specialist evaluates the hearing status, tumor size and location and tumor growth. Surgery is a common option for treatment of tumors that are large and compressing the brain, while some patients can be treated with medications (Avastin) to slow tumor growth over time. Clinical trials are ongoing to evaluate new medications in the treatment of these tumors.

Glomus Tumor

Glomus tumors (also known as paragangliomas) can occur in the skull base near the jugular vein or the middle ear. Typically, these tumors are vascular tumors, are slow growing and considered to be locally aggressive.

Symptoms can include loss of function of lower cranial nerves that control gag sensation, voicing, swallowing and shoulder or tongue movement. Other symptoms include hearing loss or a pulsating sound in the ear that sounds like a heartbeat.

Treatment options include observation of tumors to determine if there is growth. If there is growth, radiation treatment, surgical treatment, or a combination are performed to control the tumor and prevent future cranial nerve deficits.