Acoustic Neuroma & Skull Base Procedures

Breakthrough medical treatments for brain and cranial tumors

Treatment of skull based tumors can be challenging due to the delicate nerves and blood vessels near the brain.

IU Health skull base surgeons have extensive experience with craniofacial, skull-base surgical and microsurgical techniques. This includes using advanced imaging tools to successfully treat patients with deep-seated tumors and vascular lesions.

Our team includes:

  • Research specialists at Indiana University School of Medicine
  • Radiation oncologists
  • Neurosurgeons
  • Neuropathologists
  • Neuropsychologists

We make sure you receive the most innovative, comprehensive treatment from the nation's most experienced tumor specialists. We also give you a customized treatment plan for your medical condition.

IU 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
  • Paragangliomas

Our skull base surgeons also treat non-tumor conditions, such as spontaneous cerebrospinal fluid (CSF) leaks.

Aggressive surgical treatment at IU Health focuses on treatment options based on the area of tumor: inside the front, middle and rear compartments of the skull base.

Treatment depends on the type of tumor, your age and health and the tumor size. Our experts will create a patient-centered treatment plan best suited for each condition.

Acoustic Neuroma (Vestibular Schwannoma)

Acoustic Neuroma

An acoustic neuroma is a benign tumor that has the potential to affect your balance and hearing nerves.

Acoustic neuroma tumors most often occur on one side of your 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
  • In rare cases of very large tumors, confusion and headaches

Treatment options depend upon your 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 results if you have a smaller tumor. 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. Facial nerve function after surgery is good when the tumor is small.

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

Large Acoustic Clinical Trial

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

Meningioma

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. They can interfere with normal brain functions.

Meningiomas cause symptoms related to their location. 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 your age and health. Observation, radiation therapy and surgery are all options at IU Health for treatment of meningioma tumors.

Pituitary Adenoma

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
  • 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 IU 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 (CSF Leak)

CSF 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. You may have symptoms of meningitis (fever, nausea, headaches, lethargy) as the first sign of a CSF leak.

Treatment options at IU 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
  • Weakness

Other symptoms or signs include glaucoma and vision changes.

Treatment of NF2 patients requires a team of specialists with a patient-centered approach to your 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 used to slow tumor growth over time. Clinical trials are ongoing to evaluate new medications in the treatment of these tumors.

Glomus Tumor

Glmous TumorGlomus 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 done to control the tumor and prevent future cranial nerve deficits.

Treatment

Our team includes:

  • Research specialists at Indiana University School of Medicine
  • Radiation oncologists
  • Neurosurgeons
  • Neuropathologists
  • Neuropsychologists

We make sure you receive the most innovative, comprehensive treatment from the nation's most experienced tumor specialists. We also give you a customized treatment plan for your medical condition.

IU 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
  • Paragangliomas

Our skull base surgeons also treat non-tumor conditions, such as spontaneous cerebrospinal fluid (CSF) leaks.

Aggressive surgical treatment at IU Health focuses on treatment options based on the area of tumor: inside the front, middle and rear compartments of the skull base.

Treatment depends on the type of tumor, your age and health and the tumor size. Our experts will create a patient-centered treatment plan best suited for each condition.

Acoustic Neuroma (Vestibular Schwannoma)

Acoustic Neuroma

An acoustic neuroma is a benign tumor that has the potential to affect your balance and hearing nerves.

Acoustic neuroma tumors most often occur on one side of your 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
  • In rare cases of very large tumors, confusion and headaches

Treatment options depend upon your 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 results if you have a smaller tumor. 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. Facial nerve function after surgery is good when the tumor is small.

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

Large Acoustic Clinical Trial

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

Meningioma

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. They can interfere with normal brain functions.

Meningiomas cause symptoms related to their location. 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 your age and health. Observation, radiation therapy and surgery are all options at IU Health for treatment of meningioma tumors.

Pituitary Adenoma

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
  • 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 IU 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 (CSF Leak)

CSF 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. You may have symptoms of meningitis (fever, nausea, headaches, lethargy) as the first sign of a CSF leak.

Treatment options at IU 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
  • Weakness

Other symptoms or signs include glaucoma and vision changes.

Treatment of NF2 patients requires a team of specialists with a patient-centered approach to your 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 used to slow tumor growth over time. Clinical trials are ongoing to evaluate new medications in the treatment of these tumors.

Glomus Tumor

Glmous TumorGlomus 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 done to control the tumor and prevent future cranial nerve deficits.

Patient Stories for Acoustic Neuroma & Skull Base Procedures