VESTIBULAR SCHWANNOMA (ACOUSTIC NEUROMA)

Hearing Preservation • Facial Nerve Protection • Microsurgical & Radiosurgical Expertise

Overview

Vestibular schwannomas—also known as acoustic neuromas—are benign tumors that develop from the vestibular nerve, which controls balance. Although noncancerous, they can cause significant symptoms by affecting hearing, balance, and facial nerve function.

As a neurosurgical oncologist at Lenox Hill Hospital in Manhattan, Dr. Randy S. D’Amico evaluates and manages vestibular schwannomas using a multidisciplinary, patient-centered approach that emphasizes hearing preservation, facial nerve protection, and the least invasive option appropriate for each individual.

Dr. D’Amico collaborates closely with neurotology/ENT specialists, radiation oncologists, and audiologists to ensure each patient receives a tailored plan based on tumor size, symptoms, growth rate, and personal goals.

Common Symptoms

Vestibular schwannomas typically cause:

  • One-sided hearing loss

  • Tinnitus (ringing in the ear)

  • Imbalance or dizziness

  • Fullness or pressure in the ear

  • Facial numbness or tingling

  • Rarely, facial weakness

  • Larger tumors: headaches or difficulty walking

Symptoms may be subtle and progress gradually.

Diagnosis & Evaluation

Evaluation includes:

  • MRI with internal auditory canal (IAC) protocol

  • Audiogram to assess hearing thresholds

  • Vestibular testing (when needed)

  • Serial imaging to assess tumor growth

  • Review of clinical symptoms and functional goals

Accurate imaging and hearing evaluation guide whether the safest plan is observation, radiosurgery, or microsurgical removal.

Treatment Options

1. Observation (“Watchful Waiting”)

Many small vestibular schwannomas grow slowly or not at all. In these cases, monitoring with MRI every 6–12 months may be appropriate.

Ideal for patients with:

  • Small tumors

  • Minimal symptoms

  • Good hearing

  • Older age or medical comorbidities

2. Stereotactic Radiosurgery (SRS)

A non-invasive treatment using focused radiation (e.g., Gamma Knife or linear accelerator-based SRS) to control tumor growth.

Benefits:

  • Outpatient treatment

  • No incision

  • Very high tumor control rates

  • Good facial nerve preservation

SRS is especially effective for small- to medium-sized tumors.

3. Microsurgical Resection

Surgery is recommended when:

  • Tumor is large or growing

  • Hearing is declining

  • The tumor presses on the brainstem

  • Facial symptoms are worsening

  • The patient prefers definitive removal

Approaches include:

  • Retrosigmoid (possible hearing preservation)

  • Middle fossa (for small intracanalicular tumors)

  • Translabyrinthine (for non-serviceable hearing)

Dr. D’Amico works jointly with neurotology to optimize hearing preservation and protect the facial nerve.

Surgical Philosophy: Function First

Facial Nerve Preservation

The facial nerve runs directly against vestibular schwannomas.
Dr. D’Amico employs:

  • High-resolution imaging

  • Intraoperative facial nerve monitoring

  • Microsurgical and endoscopic assistance

  • Minimally disruptive dissection techniques

Hearing Preservation

When feasible, hearing-preservation approaches are used based on:

  • Tumor size

  • Tumor location

  • Preoperative hearing quality

  • Cochlear nerve anatomy

Minimally Invasive Techniques

Depending on tumor size and extension, surgery may include smaller openings, focused corridors, and exoscopic visualization.

Recurrent or Residual Vestibular Schwannoma

Tumors may recur or regrow after initial treatment. Management options include:

  • Repeat microsurgery

  • Stereotactic radiosurgery

  • Observation for slow-growing lesions

  • Facial nerve rehabilitation (when needed)

A multidisciplinary review ensures the safest strategy.

When to Seek a Second Opinion

A second opinion is helpful when:

  • You’ve been told surgery is the only option

  • Your tumor is growing, and you’re unsure if SRS is appropriate

  • You’re concerned about facial nerve or hearing outcomes

  • You want clarity on your best approach (observation vs radiosurgery vs surgery)

  • You have a complex or recurrent tumor

  • You prefer a team that emphasizes function preservation

Dr. D’Amico provides clear, individualized guidance for patients at any stage of their diagnosis.

Serving New York City & the Tri-State Area

Patients with vestibular schwannomas receive care at Lenox Hill Hospital (100 E 77th St, New York, NY 10075) with convenient access from:

  • Manhattan

  • Brooklyn

  • Queens

  • The Bronx

  • Long Island

  • Westchester

  • Northern New Jersey

Next Steps

If you or a loved one has been diagnosed with a vestibular schwannoma:

  • Request a Consultation

  • Seek a Second Opinion

  • Refer a Patient

  • Return to the Conditions Treated overview