Brain Tumor Diagnosis Doesn't Always Mean Cancer

by TerryMcNamee

When people hear the words "brain tumor" they automatically think cancer. Fortunately, brain tumors are relatively rare, and the most common ones, acoustic neuromas, are benign.

By Terry McNamee © 2013

Even benign tumors can still cause health issues if they become large enough to press on the brain or on nerves leading to the brain. But non-cancerous tumors tend to grow quite slowly, and in some cases are best left untreated as long as they do not cause problems. The most common type of benign brain tumor is an acoustic neuroma, or AN, also sometimes called a vestibular schwannoma. It grows deep inside the skull near the brain stem. Although actually located outside of the brain itself, it presses against the brain and nerves. It is non-invasive, meaning it will not penetrate the brain itself, and it will not spread to other locations, but it can grow bigger. Acoustic neuromas are found in all races and, in most cases, they are not hereditary. Benign acoustic neuromas often remain quite dormant and go undiagnosed for years.

An acoustiic neuroma on the left side of this brain scan.
An acoustiic neuroma on the left side of this brain scan.
Wikimedia Commons

Symptoms and Diagnosis of Acoustic Neuromas

Symptoms of an AN can include sudden vertigo (loss of balance) and constant tinnitis (ringing or other noises in one ear). A large tumor may cause facial twitching, headaches and lack of sensation in parts of the face on the same side as the tumor. These problems are caused by the tumor pressing on cranial nerves that carry signals to and from the brain.

Some patients, especially with a small tumor, may not experience any symptoms at all, and only discover they have an AN when an MRI (Magnetic Resonance Imagery) or CT (computerized tomography) scan done for some other reason, such as a head injury or headaches, reveals the tumor’s existence.

An acoustic neuroma often is diagnosed only after a patient develops unexplained and occasionally sudden hearing loss in just one ear. This unilateral hearing loss is a frequent indicator of an AN, and results from the tumor blocking the acoustic nerve, preventing sounds from being carried from the inner ear to the brain. Since the nerve is blocked, a conventional hearing aid is ineffective.

When a patient sees a doctor about a hearing problem in just one ear, the first step is a hearing test. If a hearing loss is confirmed, additional tests will be done, including an MRI to see if there is a tumor, since there could be other reasons for the hearing loss.

Treatment for Acoustic Neuromas

Left untreated, a slow-growing or static AN could actually cause no problems at all, although an AN that begins to grow could become life-threatening if it becomes too big. Fortunately, there are ways to detect these tumors when they are still very small, and new methods of treatment have become available in the past few years to give both patients and doctors several options.

If an AN is detected, the patient needs to discuss these options with a specialist. The size of the tumor is important. If it is less than 1.5 centimetres, the doctor may recommend a wait-and-see approach, with a follow-up MRI after six months and another every year after that to determine if the tumor is growing or remaining fairly constant.

Some ANs grow very little each year, while others can grow an average of 1.5 mm annually. They are unpredictable, and can begin growing unexpectedly after remaining virtually unchanged for years. This is why annual MRIs are needed to keep track of the growth.

If treatment is chosen, there are two basic options: physical surgery to remove the growth or radiation to kill it or at least slow its growth. There are pros and cons to each method. Either way, it is highly unlikely the patient will recover any hearing in that ear. In fact, hearing may continue to deteriorate even after treatment, and some facial paralysis can occur.

The good news is that this type of brain tumor will not spread into other parts of the body and will not invade the brain itself.

While a conventional hearing aid will not help, a cochlear implant might restore hearing in the affected ear in some individuals by sending sound signals directly to the brain, bypassing the nerve blockage caused by the tumor. This is a serious, invasive medical procedure used for people with profound hearing loss, so if the individual can still hear well in the other ear, most doctors will not recommend getting one. Some patients with neurofibromatosis 2  develop ANs on both sides of the brain, in which case a cochlear implant can restore enough hearing to be useful to the patient.

Another option for some AN patients is a Baha speech processor (bone assisted hearing aid), a device created by doctors at Johns Hopkins University's Acoustic Neuroma Center. It is a hearing aid anchored to the skull, which transmits sound waves through the bone of the skull and to the nerves of the inner ear.

Useful AN Links

The Acoustic Neuroma Association of Canada (ANAC) offers forums, lectures and links to many treatment centres. The forums are very helpful for a newly diagnosed or newly treatred patient who needs help and reassurance from others who have gone through this. There are similar associations in many other countries.

The AN Patient Archive Site provides first-hand accounts of diagnosis, treatment and problems associated with AN, all compiled by and for people living with an acoustic neuroma.

AN World is another on-line resource that gives details about what an AN is and various treatment options available.

The books listed below also offer more information useful for people diagnosed with an acoustic neuroma and their families.

A cochlear implant transmits sounds directly to the brain.
A cochlear implant transmits sounds d...
Wikimedia Commons
Updated: 05/17/2013, TerryMcNamee
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dustytoes on 05/18/2013

My oldest son has brain tumors such as this. He had gamma knife radiation which "killed" it but he is deaf in one ear. He now has another tumor that is growing slowly on the other side. Thankfully they do grow slowly.

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