An operation to remove an acoustic neuroma aims for the complete (as much as possible) removal of the tumour from the intracranium. It is performed by using an operating microscope. In the last few years an endoscope has been increasingly used as a support due to its better view of the operating area, but also partly exclusively.
In any case, an essential standard is a permanent monitoring of the auditory nerve function in the operating area, to avoid damaging the nerve during the operation. This so-called intraoperative neuromonitoring is today an essential part of acoustic neuroma treatment and a prerequisite for a successful operation for the purposes outlined at the start.
Given that an acoustic neuroma presses and damages the auditory nerves and generally begins to grow in the bony ear canal, the operative removal logically falls to the skills of the neurosurgeons and ENT surgeons. The acoustic neuroma operation is both carried out by them alone and also working as a team.
The operation is imperative if the acoustic neuroma has an average diameter larger than 3 cm and if it has already spread to the cranial fossa and is pressing on the cerebullum or/and the Brainstem, as otherwise vitally important functions could be impaired. Even if the tumour is still small, but it has already caused clear symptoms and permanent acute hearing loss or facial paralysis have to be prevented, an operation is the first choice. There is no limit on tumour sizes that support or oppose operating.