Acoustic neuroma surgery
An operation to remove an acoustic neuroma — a usually non-cancerous tumour on the balance and hearing nerve — when it is large, growing, or causing problems.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- It removes a usually benign tumour on the hearing and balance nerve, when the tumour is large, growing or causing problems.
- Surgery is not the only option — many small tumours are monitored with scans, and some are treated with stereotactic radiosurgery instead.
- Hearing on the operated side is often lost, and there is a real risk to the nerve that moves the face; both depend heavily on the tumour's size.
- It is delicate skull-base surgery best done by an experienced team, with honest discussion of what it can and cannot protect.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Can remove the tumour and relieve pressure on the brain and nearby nerves
Your tumour is small and stable, so monitoring with scans is safer than operating.
You are watched closely, often in intensive care or a high-dependency unit at first. Headache, tiredness and unsteadiness are common, and the team checks...
Close monitoring after surgery with clear written warning signs and an urgent contact route.
You are watched closely, often in intensive care or a high-dependency unit at first. Headache, tiredness and...
The wound heals and balance starts to improve as the body adjusts to the change. Balance (vestibular) exercises...
Energy returns gradually and most people are back to many activities by about two to three months. Any facial...
Balance usually continues to improve, and facial movement may keep recovering over this longer period. Some...
What is acoustic neuroma surgery?
An acoustic neuroma — also called a vestibular schwannoma — is a usually non-cancerous (benign) tumour that grows slowly on the nerve that carries hearing and balance signals from the inner ear to the brain. It does not spread to other parts of the body, but as it grows it can press on nearby nerves and, if large, on the brain itself.
Surgery removes all or part of the tumour through an opening behind or near the ear. It is one of three main ways these tumours are managed; the others are monitoring with regular scans (watch and wait) and a focused form of radiotherapy called stereotactic radiosurgery. Which option is best depends on the size and position of the tumour, how fast it is growing, your hearing, your age and your general health.
The most important thing to understand is that surgery is not automatically needed. Many small acoustic neuromas never need treatment and are simply watched, because they grow slowly and the risks of treatment can outweigh the benefit. When surgery is chosen, the main aim is to remove the tumour safely while protecting the nerve that moves the face, and sometimes hearing — but hearing on the operated side is often lost, especially with larger tumours.
Because this is delicate surgery at the base of the brain, it is best done by an experienced skull-base team (usually an ENT/neuro-otology surgeon working with a neurosurgeon). The risks depend heavily on the size and position of the tumour.
Types & techniques
There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.
Surgery, monitoring and radiosurgery compared
| Surgery | Other options | |
|---|---|---|
| Main aim | Remove the tumour | Monitor or control growth |
| Examples | Translabyrinthine, retrosigmoid | Watch and wait, radiosurgery |
| Often suits | Larger or growing tumours | Small or stable tumours |
| Hearing on that side | Often lost | May be preserved for longer |
| Recovery | Weeks to months | Usually none (monitoring) |
Many small acoustic neuromas are simply monitored with scans, because they grow slowly and around two-thirds never need treatment. Radiosurgery can control many small or medium tumours without an operation. A specialist team should explain which option fits your tumour and hearing.
Preparing for your surgery
- See an experienced skull-base team (usually an ENT/neuro-otology surgeon with a neurosurgeon) to confirm why surgery is recommended rather than monitoring or radiosurgery.
- Expect hearing tests, balance tests and detailed brain scans (MRI) before surgery.
- Ask which surgical approach is planned and whether any hearing on that side might be preserved.
- Tell the team about all medicines, especially blood thinners, and any allergies.
- Arrange about 2 to 3 months off and support at home, as recovery and balance retraining take time.
- Plan not to drive until your team confirms it is safe, and arrange a lift home.
- Ask about the chance of facial weakness and what support (such as eye protection and physiotherapy) is available if it happens.
What happens
The operation is done under general anaesthetic, so you are asleep. The surgeon reaches the tumour through an opening behind or near the ear, the exact route depending on the approach chosen and the tumour's size and position. During the operation, the team monitors the facial nerve closely to protect the movement of your face, and removes as much of the tumour as is safe.
Sometimes a small amount of tumour is deliberately left to protect the facial nerve. A sample is sent to the laboratory. The opening is closed, sometimes using a small graft of your own tissue or fat to help seal the area and reduce the chance of fluid leaking.
This is long, careful surgery and can take several hours. Afterwards you are watched closely, often in intensive care or a high-dependency unit for a day or two, before moving to a ward. Most people are in hospital for about five to ten days, and balance can feel off at first as the body adjusts.
Is this operation right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Your tumour is small and stable, so monitoring with scans is safer than operating.
- Stereotactic radiosurgery would control the tumour with less risk in your case.
- Your general health makes a long general anaesthetic and skull-base surgery too risky.
- The risk to hearing, the facial nerve or other functions outweighs the likely benefit for you.
Delay surgery if…
- There is an active infection (including an ear or sinus infection) that should be treated first, where it is not urgent.
- You are on blood thinners that need safe planning before surgery.
- Further scans, hearing tests or balance tests are needed to plan the approach.
- You need more time to weigh up monitoring, radiosurgery and surgery with the team.
Alternatives to discuss
- Watchful waiting with regular monitoring scans, especially for small tumours.
- Stereotactic radiosurgery to control growth without an operation.
- Partial removal followed by monitoring or radiosurgery to protect the facial nerve.
- Hearing devices and balance therapy to manage symptoms without removing the tumour.
- A second specialist opinion before committing to surgery.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Anaesthetic choices
The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.
Benefits
- Can remove the tumour and relieve pressure on the brain and nearby nerves
- Provides tissue for an exact diagnosis
- Can stop a growing tumour from causing further problems
- Allows close protection of the facial nerve during the operation
- May be preferred for larger tumours where monitoring or radiosurgery is less suitable
Risks & complications
- Loss of hearing on the operated side, especially with larger tumours or certain approaches
- Unsteadiness and dizziness at first, which usually improves as the body adjusts over weeks to months
- Headache and tiredness in the early period, and tinnitus (ringing) that may continue
- Weakness of the face on the operated side, which often improves over many months but can be lasting
- A leak of brain fluid (CSF) from the wound or nose, which may need further treatment
- Numbness of part of the face, or dry eye needing protection
- Infection, including, rarely, meningitis if fluid leaks
- Lasting, severe facial weakness affecting the eye, mouth and expression
- Double vision, or problems with swallowing or voice
- Bleeding or a stroke-like problem
- Serious complications that can be life-threatening; death is rare
The two biggest issues are hearing loss on the operated side (often unavoidable, especially with larger tumours) and the risk to the facial nerve, which rises sharply with tumour size. A brain-fluid leak and, rarely, meningitis are also important. Ask your surgeon about your own risks given the size of your tumour, and what support is in place if facial weakness or dry eye occurs.
Published figures to discuss
Risks depend heavily on the size and position of the tumour, the surgical approach, and your hearing beforehand. The biggest issues are loss of hearing on the operated side and the risk to the facial nerve, which both rise with tumour size. Published facial-nerve and hearing figures vary widely between studies and centres, so the wording below is cautious and source-based rather than a prediction for you.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Hearing loss on the operated side | Common; translabyrinthine surgery sacrifices hearing, while selected small-tumour hearing-preservation series report useful hearing kept in roughly 30–70% | Hearing in the other ear is not affected by the operation. | Surgical treatment of acoustic neuroma: outcomes and indications — PMCpmc.ncbi.nlm.nih.govPublished figure |
| Facial nerve weakness | Strongly size-dependent; one surgical review reported House-Brackmann grade III or worse facial dysfunction in about 7% | Often improves over many months; eye protection and physiotherapy help if it occurs. | Surgical treatment of acoustic neuroma: outcomes and indications — PMCpmc.ncbi.nlm.nih.govPublished figure |
| Brain-fluid (CSF) leak | Often around 5–15%; one surgical review reported about 10%, with older approach-specific series ranging wider | May need further treatment; a leak raises the risk of meningitis. | Surgical treatment of acoustic neuroma: outcomes and indications — PMCpmc.ncbi.nlm.nih.govPublished figure |
| Tumour coming back (recurrence) | Around 1 in 20 after removal, in NHS information | Any tumour deliberately left behind is monitored and treated if it grows. | NHS — Acoustic neuroma (vestibular schwannoma)nhs.ukPublished figure |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
Recovery — what to expect, and when
Recovery takes time. The first focus is close monitoring and getting your balance going again, then gradually rebuilding energy. Balance and any facial weakness can continue to improve for many months, sometimes up to a couple of years.
- Unsteadiness and dizziness at first that improve as your balance system adjusts
- Headache and tiredness in the early weeks
- Loss of hearing on the operated side, and tinnitus that may continue
- A numb or tight feeling around the wound, and emotional ups and downs
Aftercare
- Follow wound-care advice and keep the area clean and dry.
- Do your balance (vestibular) exercises as advised — moving about helps your balance recover.
- Avoid heavy lifting, straining, bending and blowing your nose hard in the early weeks.
- If your eye does not close fully, use the eye drops or ointment and protection advised to prevent damage.
- Do not drive until your team confirms it is safe, especially while balance is settling.
- Avoid flying until your team says it is safe (often around six weeks).
- Attend follow-up appointments and scans, and report any clear fluid leak, severe headache or fever urgently.
- Someone to help at home in the first weeks
- Eye drops or ointment and eye protection ready, in case the eye does not close fully
- A list of warning signs and an emergency contact number
- Time off work arranged (about 2 to 3 months)
- Transport sorted, knowing you may not be able to drive at first
- Balance exercise instructions understood
- Follow-up scan and clinic appointments noted
Scars and how they heal
There is usually a scar behind or near the ear, often hidden within the hairline where possible. If a small graft of fat or tissue is taken (for example from the tummy) to help seal the area, there can be a small scar there too. Scars usually fade over months, and there may be a numb area around them.
⚠ Get urgent help if…
- Clear, watery fluid leaking from the wound, ear or nose (possible brain-fluid leak)
- A severe or worsening headache, neck stiffness or sensitivity to light, with or without fever (possible meningitis)
- An eye that will not close, becoming red, dry or painful
- New or worsening weakness of the face
- New double vision, or problems with swallowing or speech
- Increasing redness, swelling, heat or discharge from the wound, or a high temperature
- Sudden severe dizziness, vomiting, drowsiness or confusion
Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A good result usually means the tumour has been removed or safely reduced, the facial nerve has been protected as far as possible, and pressure on the brain and nearby nerves has been relieved. The laboratory analysis confirms the diagnosis. Balance usually improves over the following months as the body adjusts.
Surgery cannot usually save hearing on the operated side, especially for larger tumours, and it cannot guarantee that the face will move completely normally or that tinnitus will go. A small amount of tumour is sometimes left to protect the facial nerve, and this is then monitored. The realistic goal is set with your specialist team and depends on the size and position of your tumour.
Most acoustic neuromas do not come back after they have been fully removed, but recurrence happens in roughly 1 in 20 cases, and any tumour deliberately left behind is monitored or treated if it grows. Hearing lost on the operated side does not usually return, while balance and facial movement often keep improving for many months. Your team will explain the likely outlook and how you will be followed up with scans.
Combining with other procedures
Surgery is one of three main ways acoustic neuromas are managed, alongside monitoring and stereotactic radiosurgery, and these are sometimes used together — for example, radiosurgery for a small piece of tumour left after an operation. Balance physiotherapy and, where needed, support for facial weakness and hearing (such as hearing devices for the good ear) are often part of the wider plan.
Follow-up & long-term care
You will be followed up by your skull-base team, usually with scans to check the area over time and reviews of your balance, facial movement and hearing. Physiotherapy may continue after discharge. Any warning signs — especially a clear fluid leak, a severe headache with neck stiffness, an eye that will not close, or new facial weakness — should prompt urgent contact rather than waiting for an appointment.
- Continue balance (vestibular) exercises as advised to help your balance recover.
- Protect the eye with drops or ointment if it does not close fully, to prevent damage.
- Attend follow-up scans to check for any regrowth or change in tumour left behind.
- Consider a hearing assessment and devices to help with hearing on the good side.
- Report new facial weakness, dizziness or any fluid leak early.
Revision and secondary surgery reality
- A small amount of tumour is sometimes deliberately left to protect the facial nerve, and is then monitored or treated with radiosurgery if it grows.
- Recurrence (around 1 in 20) may mean further surgery or radiosurgery over time.
- A brain-fluid leak can occasionally need a further procedure to repair it.
- Facial weakness sometimes needs separate treatment (such as eye procedures or facial rehabilitation) if it does not fully recover.
Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.
What good aftercare looks like
- Close monitoring after surgery with clear written warning signs and an urgent contact route.
- Balance (vestibular) physiotherapy to help recovery, and a named team for follow-up.
- Eye care and protection arranged if the eye cannot close fully, with facial rehabilitation if needed.
- Hearing assessment and support for the good ear where helpful.
- Follow-up scans to monitor the area and any tumour left behind.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Acoustic neuroma surgery is usually an NHS service, so private cost questions arise rarely
- Where private care applies: the ENT/skull-base surgeon's, neurosurgeon's and anaesthetist's fees
- The size and position of the tumour and the surgical approach used
- The length of the operation and any intensive care or high-dependency stay
- Imaging, facial-nerve monitoring and laboratory (pathology) analysis
- Balance physiotherapy and any support for facial weakness or hearing
- Follow-up scans and, if needed, radiosurgery for any tumour left behind
- The named surgeon's (and neurosurgeon's) fee and the anaesthetist's fee
- The hospital fee, including any intensive care or high-dependency stay
- Imaging and laboratory (pathology) costs
- Balance physiotherapy and facial-weakness support included afterwards
- Follow-up scans and how any tumour left behind would be managed
- What happens, and who pays, if a complication such as a fluid leak occurs
- Cancellation and rescheduling terms
On the NHS? Acoustic neuroma surgery is usually carried out on the NHS in specialist skull-base centres; private care is uncommon, though people may seek a private second opinion on whether to monitor, have radiosurgery or operate.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not being told that monitoring or radiosurgery may be a reasonable alternative to surgery.
- Hearing loss on the operated side not being clearly explained as often unavoidable.
- The size-dependent risk to the facial nerve, and the plan if it is affected, not being discussed.
- No clear warning signs or plan for a brain-fluid leak and meningitis.
- No discussion of eye protection if the eye cannot close fully.
Marketing red flags
- Any promise to fully preserve hearing or guarantee normal facial movement.
- Claims that the operation is without risks or routine regardless of tumour size.
- Not mentioning monitoring or radiosurgery as alternatives.
- Downplaying the rare but serious risks of meningitis, stroke or death.
- Pressure to operate quickly on a small, stable tumour without discussing watch and wait.
Choosing a surgeon safely
- Check your surgeon is on the GMC Specialist Register for this area.
- Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
- You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
- Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- Given my tumour's size, why is surgery recommended rather than monitoring or radiosurgery?
- Which surgical approach are you planning, and is there any chance of saving hearing on that side?
- What is the risk to my facial nerve, and what support is there if my face is affected?
- How much of the tumour do you expect to remove, and would any be left to protect the nerve?
- How will my balance recover, and what exercises or physiotherapy will help?
- How will I be followed up, and what is the chance of the tumour coming back?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my operation, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this operation not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Do I definitely need surgery for an acoustic neuroma?
Will I lose my hearing?
Will my face be affected?
How long will recovery take?
Is it done on the NHS or privately?
What is the difference between surgery and radiosurgery?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Acoustic neuroma (vestibular schwannoma) NHS (Leeds Teaching Hospitals) — Surgery for an acoustic neuroma NHS (University Hospitals Plymouth) — Acoustic neuroma (vestibular schwannoma) British Acoustic Neuroma Association (BANA) Stereotactic radiosurgery for vestibular schwannoma — ISRS guideline (PMC) Upfront radiosurgery versus wait-and-scan (V-REX trial) — PMC Surgical treatment of acoustic neuroma: outcomes and indications — PMC
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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