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In This Video

  • Massachusetts General Hospital has a partnership with the Massachusetts Eye and Ear to treat patients with acoustic neuromas
  • This multidisciplinary relationships between surgeons, radiation oncologists, neuro-oncologists, audiologists and rehabilitation specialists for acoustic neuromas has been built over the past 50 years
  • Acoustic neuroma surgery can range from the relatively simple to the more complex, depending on the size of the tumor
  • One treatment effort at Mass General is to supplant surgery for as many tumors as possible to minimize the risk of impacting the patient's neurological function and quality of life

The Department of Neurosurgery at the Massachusetts General Hospital has a partnership with the Massachusetts Eye and Ear to treat patients with acoustic neuromas. In this video, Bob S. Carter, MD, PhD, chief of the Department of Neurosurgery at Mass General, and neurosurgeon Frederick Barker, MD, of Mass Eye and Ear, discuss treatment options and the multidisciplinary teams that underlie care for those with acoustic neuromas.

Transcript

Bob Carter, MD, PhD: Mass General has a great partnership with the Massachusetts Eye and Ear Infirmary on the treatment of patients with acoustic neuromas. Currently we perform a variety of procedures to treat these tumors. These include therapeutic options such as surgical removal of the tumors, simple observation for very small tumors and/or radiation treatment for certain tumors that may be particularly amenable to that type of therapy. If we think about three different options for patients, some patients who require no surgery can simply be observed because their tumors are stable. Other patients may have a large and symptomatic tumor or a growing tumor and for these patients, treatment is required. We have a large group of neurosurgeons and neurotologists here both at Mass General and Mass Eye and Ear who work together each day taking care of patients with this disease.

Fred Barker, MD: The partnership with the Eye and Ear comes in for many reasons. One is that the surgery of acoustic neuromas almost always requires both a neurosurgeon with special skills and an ENT or ear, nose and throat specialist with special skills. The assessment of the hearing in each ear in each patient is done by audiologists who work over at Mass Eye and Ear and then the rehabilitation of hearing loss either in one ear or in both ears often requires both audiologists, speech therapists from the Mass General and surgeons from the Eye and Ear who have special skills in restoring hearing.

So these sorts of multidisciplinary relationships between surgeons, radiation oncologists, neuro-oncologists, audiologists and rehabilitation specialists do not develop overnight. That's the final result of so far three generations of surgeons here Mass General who have been focusing on acoustic neuromas for basically the last 50 years. My partners from the Eye and Ear have had decades of experience with hundreds or more than a thousand acoustic neuroma operations.

Bob Carter, MD, PhD: Acoustic neuroma surgery can range from relatively simple to more complex depending on the size of the tumor. For example, a small tumor may be treated in just a short procedure, a middle fossa approach or retro sigmoid approach, which can be accomplished within a couple of hours. Some patients come in with very large tumors. The goal here is to make sure that the patient's facial nerve is working to the best possible degree. If a small residual amount of tumor is left behind at the time of surgery we have the capacity to bring to bear specialized radiation therapy. Our Radiation Oncology Department here has one of the world's leading centers in proton therapy for acoustic neuromas. This particular type of radiation has the ability to set margins that protect the normal brain structures and also prevent damage to the critical nerves themselves.

Fred Barker, MD: But in addition to surgeons we need other physicians who have finely honed skills in treating acoustic neuromas using other modalities. The treatment of acoustic neuroma using drugs was revolutionized here about 10 years ago by Dr. Scott Plotkin in the Neurofibromatosis Clinic. He found that the drug bevacizumab, which was actually developed for use in cancer, can actually restore hearing to many patients who have lost hearing from bilateral acoustic neuromas—acoustic neuromas on both sides. One of the efforts here is to use drug treatment to eventually entirely supplant surgery for as many tumors as possible in this area because surgery will always have the risk of impacting on the patient's neurological function and hence on their quality of life.

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