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Abstract: The patient had progressive hearing loss and tinnitus discomfort since 2008, which was not taken seriously at the time and therefore was not treated effectively. Later, the patient came to our hospital for repeated dizziness and discomfort with no obvious cause, and was diagnosed with auditory neuroma, which had developed into brainstem compression. Since the patient’s tumor was already compressing the brainstem, surgical treatment was risky, so he was treated with radiofrequency knife. After treatment, the patient’s condition was controlled.
Basic information】Male, 63 years old
Disease Type】Auditory neuroma
Hospital】Huashan Hospital of Fudan University
Time of consultation】October 2017
Treatment plan】Shot-wave knife treatment + mannitol injection
Treatment Period】1 week of inpatient treatment, 3.5 years of follow up
Effectiveness】Tumor size gradually reduced, brainstem compression released
I. Initial consultation
The patient, 63 years old, began to have progressive hearing loss in 2008, accompanied by left-sided tinnitus. It was not until 10 years later that the patient went to our hospital in October 2017 with recurrent dizziness and discomfort with no obvious cause, and without symptoms such as nausea, vomiting, and visual disturbance. The patient was advised to undergo a cranial MRI, and the results suggested the presence of a left-sided auditory neuroma with a tumor size of approximately 29.4 × 23.2 × 25.9 mm, which had developed into brainstem compression, but the patient had not yet developed symptoms such as facial palsy. For further treatment, the patient was admitted to the hospital.
II. Treatment process
Considering that the patient’s tumor had compressed the brainstem and was surrounded by important structures such as facial nerve, if surgery alone was performed to remove the tumor, it might damage the surrounding tissue structures and cause risks such as facial palsy, hearing loss or even hearing loss. After informing the above risks to the patient and his family, the patient and his family were afraid of surgical treatment and showed resistance.
This will reduce the likelihood of facial paralysis and other dysfunctions. It is also a convenient, simple and safe procedure because it does not require anesthesia. After consideration, the patient and his family finally requested the radiofrequency knife treatment. A total of three sessions of radio wave knife treatment were subsequently performed at our hospital. During the treatment, the patient might develop cerebral edema in the peripheral tissues, so he was treated with mannitol injection and other drugs to reduce the edema.
III. Treatment results
The patient was hospitalized for 1 week without any other abnormal reaction, so he was discharged from the hospital for recuperation, and was instructed to come for follow-up every 6 months. After a series of treatment and review, the patient’s tumor gradually decreased, and the magnetic resonance signal in the tumor changed and multiple non-enhancing cystic areas were seen.
The patient’s tumor size was about 29.4×23.2×25.9mm and there was brainstem compression before the radiofrequency knife treatment. 1.5 years after the treatment, the tumor size was found to be about 19×20×20mm and there was no brainstem compression. Two and a half years after treatment, the patient’s tumor size was found to be 13×17×17mm and no brainstem compression was seen. Three and a half years after treatment, the patient’s tumor size had been reduced to 11×15×15mm, and still no brainstem compression was seen, and no neurological dysfunction such as facial palsy had ever occurred. The patient can be said to have achieved a more desirable treatment effect by combining the results of multiple reviews.
IV. Notes
We are glad that after a series of treatments, the patient’s tumor gradually decreased in size without surgery, the brainstem compression was released, and no other neurological dysfunction occurred, so the treatment result was satisfactory. However, since the patient’s auditory neuroma still exists and the radiofrequency knife treatment is not permanent, the patient is also at risk of recurrence. Therefore, the patient needs to pay attention to follow the doctor’s prescription for regular follow-up, usually every six months to review the cranial enhancement MRI to observe the change of tumor size and MRI signal.
Once there are signs of recurrence, the tumor can be treated again with radiosurgery (radio wave knife or gamma knife) or surgically removed. However, at present, radiosurgery is a more mature technique for the treatment of auditory neuroma within 3cm, so patients need not worry too much.
V. Personal insight
With the development of society, people have higher and higher requirements for quality of life, especially for benign tumor patients, while treatment is not only considering how to control and remove the tumor, but also must pay attention to the patient’s quality of life. For benign tumors such as auditory neuroma, life expectancy is usually not affected, so the quality of life of patients and the management of side effects become issues that we must consider during treatment. The advent of minimally invasive or even non-invasive technologies such as radio wave knife and gamma knife has enabled patients to maintain a high quality of life while undergoing treatment, which is a joyful thing for both patients and medical practitioners.
In addition, auditory neuroma grows very slowly and may only grow about 1mm per year or even not at all. However, as the tumor grows, it often affects the peripheral nerves and other structures, causing symptoms that are often irreversible, so the smaller the tumor and the less severe the symptoms are, the better the prognosis is when treated. The analysis of the past medical history of this patient shows that the patient actually had symptoms in 2008, but the best time for treatment was missed because he did not seek medical attention in time, but the patient’s prognosis is good through radiofrequency knife treatment, which is lucky for the patient. Therefore, if you experience unilateral tinnitus or hearing loss in your life, you should not take it lightly, and you should be aware of auditory neuroma and seek medical attention and treatment in a timely manner.