Surgery, also known as Microsurgery, is physical intervention of the body for a treatment. Like any other form of treatment, it is not without risk.
Surgery is currently the ideal treatment for tumors for people with NF2. While NF2 tumors are slow growing, it can allow the brain and body to have time to try to adapt and adjust which can allow a tumor to grow to a considerable size before treatment might be necessary. Continuous growth of any tumor or tumors can result in a serious health issue with the need for surgical intervention dependent on tumor size, location and how bad the side effects are or can become if a tumor increases any further. Individuals with NF2 can develop two but up to hundreds of tumors, but not every tumor that grows will require treatment.
Reasons surgery might be required could be; 1) dangers to one nerve, 2) danger to multiple nerves, 3) brain compression, or 4) brainstem compression.
Tumors in different locations brain and body grow at different rates, brain tumors often grow faster than spinal cord or body tumors, but even tumors in different areas of the brain would likely grow at different rates in the same individual.
Tumor growth for individuals with NF2 is the result of damage of a tumor suppressor element that is meant to prevent growth of tumors. Since it is not in the body to fight growth, radiation or radiosurgery treatment options which put individuals at risk of other tumor growth, might help treat one tumor but risk creating or risk growth of other tumors in the surrounding areas up to many cm away from the treated tumor.
It is always possible a tumor may seem to grow back after surgery, however, NF2 tumors, Schwannoma, but especially Vestibular Schwannoma (VS) are difficult to have completely removed if not removed by a surgeon who has removed NF2 VS. The growth of these tumors is often different from the Vestibular Schwannoma growth of individuals who might have these tumors are but not as a result of NF2. A different name for NF2 VS is currently being considered.
Some surgical options are described here.
Decompression, also known as Resection or Excision, is currently the most effective means of tumor management for NF2 at this time. However, since this only helps one tumor at a time and individuals with NF2 tend to have a vast number of tumors, a better treatment needs to be found.
With Decompression Surgery, there are two options:
Excision, complete removal is the ideal option when possible. It guarantees the tumor would not need to be dealt with again to cause future complications unless it for some reason grows back.
There are different types of tumors, but Schwannoma tumors grow as a part of the nerve, and complete removal of these tumors can cause damage to a vital nerve. If a tumor is large enough, partial removal can relieve pressure of the immediate health issue. However, this typically results is tumor regrowth and there is no way to know at what rate before more issues arise to require additional surgery later. It is important to understand that Cranial Nerves, also known as major nerves in the brain, do not heal like nerves in other parts of the body and damage done will not repair itself.
In an attempt for the body to heal, each surgery will result in Glial Scars. This buildup of damaged cells in the brain can eventually result in seizures.
Endoscopic Endonasal Surgery is the removal of a tumor through the sinuses and the Transorbital Neuroendoscopic Surgery (TONES) Approach), is surgery through the eye.
Due to a lack of MERLIN (Moesin-Ezrin-Radixin-Like Protein), which is the result of the missing or mutated Tumor Suppressor Gene, individuals with NF2 develop an overabundance of Schwann Cells. The result of this overabundance of cells is the growth of Schwannoma tumors along nerves in the Central Nerve System. The highest concentration of Schwannoma tumors typically grow on the Vestibular Nerves, this is why they are called Vestibular Schwannoma. The Vestibular Nerves are responsible for balance, but balance issues can also be adapted for visually and other parts of the brain over time and with physical therapy. Tumors that grow on a Vestibular Nerve will typically also damage the Cochlear Nerve. The Cochlear Nerve is responsible for the function of the Cochlea and therefor hearing.
The Vestibular Nerve and the Cochlear Nerve are nerve branches of the Vestibulocochlear Nerve, CN8. The three surgical approaches used to remove Vestibular Schwannomas (Acoustic Neuromas) include the: Translab Approach, Mid Fossa Approach and Suboccipital Approach. 
With the Translab Approach, the surgical entry point to remove a tumor is through the ear canal.
With the Mid Fossa Approach, the surgical entry point to remove a tumor is over and forward from the ear.
With the Suboccipital Approach, the surgical entry point to remove a tumor is behind and below the ear.
Decompression of the Middle Cranial Fossa, the canal that holds the tumor and the nerve, take the bone
out around it and see if you can relieve the pressure. Unlike the Translab, Mid Fossa and Suboccipital Approach this is not a
long term solution.
Surgeries included above might require:
There is a better quality of sound with a Cochlear Implant, but monitoring the Auditory Nerve during surgery would allow for an Auditory Brainstem Implant (ABI) if this nerve is not strong enough following tumor removal. Surgery later just to implant an ABI at a later point would result in an individual being deaf for months and is otherwise an invasive surgery.
If the Facial Nerve (CN7) might be damaged during surgery, either an EMG or a Mechanical-Pressure Monitor might be used to monitor the nerve strength. If the Facial Nerve loses connectivity during surgery, a Nerve Graft might be done when the nerve is being damaged, or later in Facial Reanimation Surgery as well as the possibility of a Free Muscle Transplant.
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