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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Treatment For Recurring Acoustic Neuroma During Pregnancy

Hi Dr. Pravar. My daugther s Acoustic neurinoma was discovered at the age of 22 in year 2001 at a size of 2.5x3.5 cm, was partially removed with microsurgery. The operation was successful, her facial nerve did not get paralyzed (her hearing was already very little in the right ear at the time of operation, it became zero afterwards). The tumor started to regrow after 4 years, then she became pregnant; during pregnancy the tumor unfortunately grew to almost its original size...in 2009 she underwent fractionated radiotherapy (LINAC) during 5 weeks altogether 52 Gy. As a result the tumor shrinked by appr. 20-25% which we are very happy about. My daughter would prefer to have another baby - but concerned about possible regrowth of the tumor again...we went through a lot of literature on internet etc. but could not find anything about what can be expected during pregnancy after radiosurgical treatment of AN. We already know that her type of tumor responds well and tends to grow in pregnancy, read that salvage surgery after radiotreatment of AN is very difficult and likely to result in facial palsy. We would appreciate if you could provide some insight of such cases in your practice or any related info or contact that can be useful for taking this important decision (perhaps not my daughter is the only one facing such tough situation).
Mon, 25 Jan 2016
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Neurologist, Surgical 's  Response
Hello. Thanks for asking form HCM.


I can understand your concern. It is good that her tumor responded to radio surgery. As you are already aware of relation of tumor with pregnancy. I will just mention few important points

: This tumor is usually more vascular and larger in size in pregnant patient. It means surgical removal leads to more risks. But vascularity decreases after pregnancy. So you can opt for surgery as she is not pregnant now.

: Regarding damage to facial nerve, the risk is always there. Main goal of surgery is to preserve facial nerve. Use of nerve monitoring and size of tumor less than 4 cm, surgical approach like translabyrinthine (if complete hearing loss) help in decreasing chances of facial nerve injury. You can discuss these options with her doctor.

: If you choose no surgery than also, you are taking risk of facial nerve damage. As it will be damaged as tumor will progressively grow in size.

: She is already received radiotherapy twice. It is better not to opt for it again as it can increase risk of intracranial malignancy (radiation induced).

At our institution, we operate neuroma by open surgical approach along with endoscopic assistance to completely remove it. We operate it after delivery of baby and explaining about risks of surgery.

Hope it will help you. Take care.


Thanks.
Dr Ishu Bishnoi
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Suggest Treatment For Recurring Acoustic Neuroma During Pregnancy

Hello. Thanks for asking form HCM. I can understand your concern. It is good that her tumor responded to radio surgery. As you are already aware of relation of tumor with pregnancy. I will just mention few important points : This tumor is usually more vascular and larger in size in pregnant patient. It means surgical removal leads to more risks. But vascularity decreases after pregnancy. So you can opt for surgery as she is not pregnant now. : Regarding damage to facial nerve, the risk is always there. Main goal of surgery is to preserve facial nerve. Use of nerve monitoring and size of tumor less than 4 cm, surgical approach like translabyrinthine (if complete hearing loss) help in decreasing chances of facial nerve injury. You can discuss these options with her doctor. : If you choose no surgery than also, you are taking risk of facial nerve damage. As it will be damaged as tumor will progressively grow in size. : She is already received radiotherapy twice. It is better not to opt for it again as it can increase risk of intracranial malignancy (radiation induced). At our institution, we operate neuroma by open surgical approach along with endoscopic assistance to completely remove it. We operate it after delivery of baby and explaining about risks of surgery. Hope it will help you. Take care. Thanks. Dr Ishu Bishnoi