Understand the main vestibular schwannoma treatment options, including surgery, monitoring and Gamma Knife radiosurgery to make an informed treatment decision.
Being told you have a vestibular schwannoma (also known as an acoustic neuroma) naturally brings strong emotions and raises many questions.
It is a rare, typically benign tumour that develops on the balance and hearing nerve (the vestibulocochlear nerve) between the inner ear and the brain.
While they can have serious side effects, vestibular schwannomas are slow-growing and treatable or manageable. The key question becomes: what is the right option for you?
Vestibular schwannoma treatment decisions depend on tumour size, growth rate, symptoms, age, overall health and personal priorities. Below is a clear overview of the three main approaches.
A vestibular schwannoma is a non-cancerous tumour arising from Schwann cells that insulate the balance nerve. Most occur sporadically. A small number are associated with genetic conditions such as Neurofibromatosis type 2.
Common symptoms include:
Because these tumours grow slowly, some are discovered incidentally during MRI scans for unrelated symptoms.
Not necessarily. For small tumours with minimal symptoms, active surveillance, often called “watch and wait”, may be appropriate. This involves:
Many small vestibular schwannomas grow very slowly, and some may not grow at all for years. However, surveillance requires commitment. If the tumour shows growth or symptoms worsen, treatment may then be recommended.
Microsurgical removal is traditionally used for:
Surgery is performed under general anaesthetic and involves opening the skull. The aim is complete or near-complete removal.
Potential benefits:
Risks to consider:
For younger, otherwise healthy patients with large tumours, surgery may still be the most appropriate option. Decisions are usually made within a multidisciplinary team.
Yes, and for many patients with small to medium-sized tumours, this is a highly effective alternative.
Gamma Knife radiosurgery is a form of stereotactic radiosurgery. Despite the name, it involves no incision. Instead, hundreds of precisely focused radiation beams target the tumour in a single session, while sparing surrounding healthy tissue.
It is particularly suitable for:
Key advantages:
The goal of radiosurgery is not to remove the tumour, but to stop or slow its growth. Over time, the tumour may shrink or remain stable.
One of the most important considerations for many patients is whether hearing can be preserved.
Hearing preservation depends on:
Smaller tumours treated early with radiosurgery may offer better chances of maintaining useful hearing compared to surgery for larger tumours. However, no option guarantees hearing preservation.
A specialist team should discuss realistic expectations based on your individual MRI and audiology results.
Treatment planning for Gamma Knife surgery involves high-resolution MRI imaging. A specialist team, including neurosurgeons, oncologists and medical physicists, designs a personalised treatment plan.
During treatment:
There is no one-size-fits-all answer.
Your decision should consider:
You should feel confident that your case has been reviewed by clinicians experienced in both surgery and radiosurgery, not just one modality.
Vestibular schwannomas are benign and manageable. The most important step is ensuring you receive balanced, expert advice tailored to you.
If you would like a specialist opinion on your treatment options, contact our team at Amethyst Radiotherapy to arrange a confidential consultation.
Centres of Excellence for Stereotactic Radiosurgery treatment of complex Brain Tumours
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