This leaflet aims to explain what will happen before and after your surgery for an Acoustic Neuroma. Please also see the general surgical information in the leaflet ‘Acoustic Neuroma’. There are two surgical approaches. The first is called a translabyrinthine approach. This involves accessing the tumour by making an incision in the scalp behind the ear and removing the bone and hearing apparatus in order to gain access to the acoustic neuroma. The second is called a retrosigmoid approach, this involves making an opening in the skull called a craniotomy to gain access to the acoustic neuroma. The skull is replaced and secured at the end of surgery.
Pre-assessment
Before your operation you will receive two pre-assessment appointments. This will include a telephone appointment to discuss your medical history and medications. You will also have a face-to-face appointment which includes having blood tests, routine swabs taken and your vital signs checked.
Pre-habilitation
You may also be offered the opportunity to attend a pre-habilitation appointment. This involves meeting with your Nurse Specialist, an occupational therapist and physiotherapist to discuss what to expect following surgery and to help you prepare for your surgery.
What to bring into hospital with you?
We recommend you bring a small bag containing Pajamas, comfortable clothes and shoes, toiletries and activities for entertainment i.e. book, puzzle book.
Please note, toothbrushes, toothpaste, shower gel, spare pajamas, underwear and towels can be provided by the ward if required.
We advise for you not to bring any personal items including valuables on the day of surgery and ask that you arrange for these to be brought in for you the following day. This is because you are unlikely to need them and as you will be transferred between different wards and departments, there is risk of them getting lost.
The day of the operation
You will be sent a letter with the details of your surgical admission which will include what to bring into hospital with you and fasting instructions. You need to wear a gown and surgical stockings (to prevent blood clots in the leg) which the ward will give you. You will be seen by an anaesthetist and your surgeon who will obtain your consent for the operation.
After surgery
You will wake up in the theatre recovery room. When ready, you will be transferred to a critical care ward; this will be the Neurosurgical High Dependency Unit (NHDU) or Neurosurgical Intensive Care Unit (NICU) for close monitoring.
You will stay there until you are well enough to be transferred to the Neurosurgical ward.
Other surgical considerations
Please note that the list below will only apply for patients who are having Acoustic Neuroma surgery via the Translabyrinthine approach.
1. Using fat in wound closure
Fat is usually taken from your thigh in order to pack closed the wound behind your ear. This means you will have a wound on your thigh which may initially feel tender.
2. Lumbar drain insertion
A lumbar drain is a soft, thin tube which is inserted into your lower back once you are under anaesthetic, this allows drainage of CSF (cerebro-spinal fluid). This decreases the risk of a CSF leak while the wound is healing. Please see CSF leak section for further information.
Potential issues following surgery
There are issues which can affect patients following surgery and these are covered below. Please note that all the issues listed may not apply to you and can depend on the size of the tumour you have had removed.
Hearing and Tinnitus
As a result of the surgery, you will completely lose your hearing in the affected ear. Some patients will continue to suffer with tinnitus even if all their hearing is lost.
Balance
Dizziness, vertigo and nausea are all common symptoms after this surgery. Usually these symptoms settle down as the brain adjusts. For a few days movement of the head may cause nausea and sickness. Medication can be given to improve these symptoms.
If there are issues with your balance, the physiotherapy team will work with you whilst you are in hospital and arrange outpatient follow up as required after discharge.
Headaches
Headaches immediately after surgery are common and usually resolve overtime. Some people do suffer with persistent headaches after surgery and simple painkillers can help. If you have headaches which do not resolve after taking painkillers, along with sensitivity to light, neck stiffness and vomiting then please seek medical attention.
CSF Leak
CSF is fluid that circulates around the brain and provides protective cushioning. In an operation on the brain and the inner ear this fluid can leak from the brain into the middle ear. The Eustachian tube connects the ear and nose, this means that CSF can leak from the brain to the back of the nose. Infection can spread up to the brain from this open passage and could cause meningitis (infection around the brain).
It is very important to inform medical staff if you have any fluid leaking from the nose. A CSF leak requires medical management. This is more likely to happen when straining such as lifting heavy objects or while straining on the toilet.
Facial weakness
The facial nerve is responsible for movement of the muscles of the face.
After surgery you may have one or more of the following:
- some facial weakness
- your eyelid may not close all the way
- the wrong movement of some muscles of your face
- a dry eye or too many tears
- a change in your sense of taste
This is because the facial nerve lies alongside the vestibular nerve and is manipulated during surgery. The consultant uses a facial nerve stimulator during the surgery, this is to monitor the facial nerve function and reduce the risk of permanent damage to the nerve. As you recover from the surgery facial symptoms should slowly improve and can continue to improve for up to 18 months, however, sometimes these changes can be permanent.
The physiotherapist/speech and language therapist will give you some initial advice about management of facial weakness and refer you on for outpatient follow up as required.
Facial weakness can occur up to a few weeks after surgery so it can occur following discharge home.
Eye care
If you have facial weakness after your surgery you may have difficulty closing your eye.
Depending on the amount of difficulty you have, you might need to see the eye specialist before being discharged home. Even if you don’t see the eye specialist after your operation, it is very important that you take great care of your affected eye. If your eye does not close properly it is at increased risk of injury and infection. It might also become dry as tears may not be produced. If needed, we will prescribe eye drops and eye ointment for you to take home:
Eye drops should be used to keep the eye moist during the day and before bed.
Eye Ointment should be used at night. It can be used during the day, but it can blur vision. Put the ointment in after the drops otherwise the drops wash the ointment out!
If the eye does not close properly then this will need to be taped closed at night. The ward staff will show you the correct eye taping technique prior to your discharge home.
If your eye becomes red, sore or irritable, then ask early advice from your GP or ophthalmologist as this could be the start of an eye infection, and it may need to be treated.
Double vision
There is a risk of double vision following surgery on large tumours. This is because two of the nerves which control the muscles for eye movement can be affected at the time of surgery. Rarely are these nerves irreversibly damaged and full recovery is expected by 12 – 18 months. Prism lenses in glasses or wearing an eye patch over one eye, can be used to help this problem.
Altered taste and dry mouth
Some patients find that after surgery they have altered taste and a dry mouth. This is because part of the facial nerve controls the sensation of taste. This should improve if the facial nerve is working at the end of the operation.
Swallowing
The nerve controlling swallowing also lies close to the acoustic nerve and can be affected but this is rare. This will mean that the ability to swallow may be difficult for a few days after the operation. Until the swallowing reflex returns you may need to be fed through a tube from the nose to the stomach to avoid food or liquids going the wrong way and into the lungs.
Wound Issues
There is a risk of having issues with your wound post surgery. To help reduce this risk, the wound will be checked regularly by the staff on the ward during your inpatient stay. Issues to look out for include; leakage from the wound, swelling around the wound site and signs of infection (high temperature above 38°C or pus oozing from the wound).
When you have been discharged home, it is important to regularly check your wound and if you notice any of these issues then please contact the ward you were discharged from (L24 or L25) for further advice.
Fatigue
As you have had major surgery, it is common to feel tired following this. Towards the end of your hospital stay you may feel less tired, however, once you return home, you may find that you become tired again. This is usual as there is more to do at home. You may find it useful to have a rest in the afternoon until your energy returns. Try to avoid sleeping for longer than 30 – 45 minutes as it may disturb your sleep at night.
It is very important that you do not do too much when you get home. A slow, gradual increase in your activity level will help you to recover and will avoid the side-effects of immobility. Where possible, try to plan and pace activities, taking regular breaks to avoid becoming exhausted. If you become tired then stop. And if you are exhausted the next day then, rest and recuperate.
The length of recovery from fatigue is variable and is based on your individual circumstances.
Advice and support can be obtained within the occupational therapy service should you continue to have issues with this.
You may have sex when you feel able to do so.
Going home
You will be able to go home as soon as your doctors, nurses and therapists are happy with your progress; this will usually be about seven to ten days after surgery. Your wound/s will be checked to make sure there are no signs of leakage or infection.
Informing your GP
The ward will send a electronic letter that summarises your stay in hospital. This will inform your GP of the details of your surgery and any medication that we have prescribed for you. You do not need to make an appointment to see your GP unless the ward have specifically asked you to do so or you have any problems.
Out-patient follow-up
You will receive an appointment via post for an MRI scan 3 months after your surgery. Following this you will be seen in the Acoustic Neuroma clinic where you will be reviewed by the Consultants and will be able to see your MRI scan.
Returning to work
It is usual for people to remain off work for 2 – 3 months following this surgery however, can it can be longer than this. It can take a long time to build up your energy levels. Do not be tempted to go back to work early as this is likely to cause you to become tired very quickly. If you have a job that you can go back to work on a part-time basis, then take this opportunity and gradually build up to your previous hours. Only you will really know when you feel able to go back to work.
Flying
You should be safe to fly six weeks following surgery. You will need to disclose to your travel insurance provider about your condition/treatment prior to travel to ensure you have appropriate cover.
Driving
It is advised you inform the DVLA that you have had surgery. The DVLA’s advice is that you do not return to driving until fully recovered from the surgery. The main thing to be aware of is your co-ordination.
This varies enormously between patients and depends on your ability to perform an emergency stop, being able to glance in your mirrors and being able to look from right to left without feeling sick and dizzy. Once you feel able to do these, you can start driving again. Begin by driving in daylight on simple routes that you know well. Occasionally patients with large tumours may have other complications causing an epileptic fit. If this happens you must not drive and you must tell the DVLA.
Meet the team
- Mr Sanjay Verma – Consultant ENT Surgeon
- Mr Kenan Deniz – Consultant Neurosurgeon
- Mr Nick Phillips – Consultant Neurosurgeon and Gamma Knife Specialist
- Alice Tonks – Acoustic Neuroma Clinical Nurse Specialist,
- Tel: 0113 206 8185 – Please note this is a voicemail service, please leave a message and your call will be returned.
- For administrative inquires including referrals and appointments, please contact the Multi-Disciplinary Team (MDT) Coordinator ……………………………….. on
0113 39………………… - Lynne Skirrow – Mr Verma’s Secretary, Tel: 0113 392 2183
- If you require surgery and are under the care of Mr Deniz and have an administrative inquiry please contact his secretary Vanessa Moss on 0113 392 3623.
Contact numbers and visiting information
Ward L26
Phone Number: 0113 392 7426
Admissions Unit. No visiting. Old Site, LGI.
Ward L24
Phone Number: 0113 392 7424
G Floor Jubilee Wing, LGI.
Ward L25
Phone Number: 0113 392 7425
G Floor, Jubilee Wing LGI.
Ward L02
Phone Number: 0113 392 7402
High Dependency Unit, C Floor, Jubilee Wing LGI.
Ward L03
Phone Number: 0113 392 7403
Intensive Care Unit, C Floor, Jubilee Wing LGI.