the Impact of Acoustic Neuroma Surgery on Nerve Function and Recovery

Acoustic neuroma

After the craniotomy, the removal of cranial nerves 7 and 8 was performed.
The surgery took place on the morning of October 29 and lasted until the afternoon, after which my mother was transferred to the intensive care unit.
This year, my mother was diagnosed with a 3.6 cm vestibular schwannoma.
Without fully understanding the situation, she underwent five sessions of stereotactic radiation therapy at the hospital.
However, less than a month after completing the treatment, she continued to feel unwell, and her condition worsened.
After transferring to another hospital, it was found that the tumor had increased in size to 4.8 cm.
Due to severe dizziness, vomiting, and pain, she was subsequently hospitalized.
The doctor stated that a craniotomy was necessary.
Before the surgery, the physician informed us of the potential complications and the possible impact on the 12 pairs of cranial nerves.
It was communicated that the auditory nerve and facial nerve could not be preserved, leading to the confirmed removal of cranial nerves 7 and 8.
Initially, we thought that the only issues would be loss of hearing on the right side of the face, but it turned out that there were additional problems, including swallowing difficulties, nystagmus, balance issues, and speech difficulties.
Prior to the surgery, my mother only experienced neck pain, numbness in her limbs, and severe dizziness and vomiting, with no history of mobility or speech impairments, or hypertension.
Now, although she has been transferred to a regular ward, she is unable to walk, eat, or speak.
Upon researching related medical information, I discovered that the eighth cranial nerve (vestibulocochlear nerve) consists of two parts: the cochlear nerve, which transmits auditory information, and the vestibular nerve, which is responsible for balance.
I am at a loss and would like to inquire about the impacts and potential complications of losing these two nerves.
Will the balance issues be a result of the nerve removal, making it unlikely for her to walk normally in the future? Are there any remedial measures? My mother is only 48, not yet 50 years old.
I understand that once cranial nerves are lost, they cannot be regenerated from the brainstem.
Does this mean she will require 24-hour care for the rest of her life? Please, tell me the truth so that I can mentally prepare for the future.
I plead for assistance.
Although the doctor discussed all 12 pairs of cranial nerves and the potential risks before the surgery, it seems that due to medical disputes, all possibilities were communicated.
What exactly will be the future implications of losing these cranial nerves 7 and 8? The swallowing issues persist without improvement; she always chokes when drinking water.
Why is that?

Qiong, 20~29 year old female. Ask Date: 2013/11/13

Dr. Ding Xianwei reply Neurosurgery

Due to the lack of any data and not having personally examined you, I can only provide insights based on your information.
It is essential that you have a detailed discussion with your attending physician to find the appropriate treatment.
An acoustic neuroma, as the name suggests, is a tumor that grows on the auditory nerve.
Given its current size, it is likely that the auditory nerve has already been compromised, and the seventh cranial nerve may also be affected.
Since I have not seen the patient, I cannot assess the tumor's impact on these two nerves or other nerves.
Furthermore, only your attending physician will have knowledge of the surgical situation, so I cannot provide you with much advice!

Reply Date: 2013/11/13

More Info

The situation you are describing regarding your mother's surgery for an acoustic neuroma and the subsequent loss of cranial nerves is indeed complex and challenging. The acoustic neuroma, also known as vestibular schwannoma, primarily affects the eighth cranial nerve, which is responsible for hearing and balance. The surgery to remove such a tumor can lead to significant complications, particularly when the tumor is large or when it has invaded surrounding structures, including other cranial nerves.

Impact of Nerve Loss
1. Hearing Loss: The removal of the cochlear portion of the eighth cranial nerve results in permanent hearing loss in the affected ear. This is often one of the most immediate and noticeable effects post-surgery.

2. Balance Issues: The vestibular portion of the eighth cranial nerve is crucial for maintaining balance. Its loss can lead to vertigo, dizziness, and difficulties with coordination. Patients may experience a sensation of spinning or unsteadiness, which can severely impact their ability to walk and perform daily activities.

3. Facial Nerve Dysfunction: The seventh cranial nerve controls the muscles of facial expression. If this nerve is damaged or removed during surgery, it can lead to facial weakness or paralysis on the affected side, impacting the ability to smile, close the eye, or perform other facial movements.

4. Swallowing Difficulties: The loss of nerve function can also affect swallowing, leading to dysphagia (difficulty swallowing). This can result in aspiration, where food or liquid enters the airway, leading to coughing or choking. This is a serious concern as it can lead to aspiration pneumonia.

5. Speech Difficulties: Damage to the nerves that control the muscles involved in speech can lead to dysarthria, where the clarity and strength of speech are affected. This can make communication challenging.

6. Other Neurological Symptoms: Depending on the extent of the surgery and the nerves involved, patients may experience a range of other neurological symptoms, including problems with eye movement (nystagmus), coordination, and even cognitive changes.

Long-term Considerations and Rehabilitation
1. Rehabilitation: After such significant nerve loss, rehabilitation becomes crucial. Physical therapy can help improve balance and mobility, while occupational therapy can assist with daily living skills. Speech therapy is essential for addressing swallowing and communication issues. Early intervention in rehabilitation can lead to better outcomes.

2. Supportive Care: Given the potential for long-term disability, your mother may require ongoing support. This could include assistance with daily activities, mobility aids, and possibly home health care services.

3. Psychological Support: The emotional and psychological impact of such a significant change in health status cannot be underestimated. Counseling or support groups may be beneficial for both your mother and family members as you navigate these changes.

4. Monitoring and Follow-up: Regular follow-up with healthcare providers is essential to monitor recovery and manage any complications that arise. This includes regular assessments of swallowing function and balance, as well as potential interventions if issues persist.

Conclusion
The loss of the eighth cranial nerve and the facial nerve can lead to profound changes in quality of life. While the immediate aftermath of surgery can be daunting, with appropriate rehabilitation and support, there is potential for improvement in function over time. It is important to maintain open communication with healthcare providers to understand the prognosis and to explore all available resources for rehabilitation and support. Your mother’s age and overall health prior to surgery may also play a role in her recovery trajectory, and a multidisciplinary approach will be key in addressing her needs moving forward.

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