Acoustic Neuroma

Definition: This is an intra-cranial (within the head but outside the brain) tumor that arises from the superior vestibular nerve (a nerve for balance). The more accurate term is therefore vestibular schwannoma.

Histopathology: They are firm and encapsulated and classified as benign. Antoni A and Antoni B biphasic patterns are found. They can be cystic, hemorrhagic or entirely solid tumors. Malignancy is rare.

Location: It starts in the internal acoustic meatus but can grow medially towards the brainstem and occupy space in the cerebellopontine angle.
Related tumors: Trigeminal schwannoma and the rare facial nerve schwannoma can occur in the same location (CP angle).

Symptoms / Presentation: This includes tinnitus (ringing in the ears), hearing loss, imbalance, numbness of the face (caused by compressing nerves, brainstem and cerebellum in the CP angle as the tumor grows). Large tumors may cause hydrocephalus by obstructing CSF circulation and this may cause symptoms related to this condition.

Diagnosis: It can be overlooked in the early stages and the diagnosis missed as tinnitus and mild hearing loss are often not investigated with MRI scanning. The best single test is MRI of the brain and IAM (internal acoustic meatus) with contrast (gadolinium). Hearing and balance tests can document the effects of the tumor.

Treatment: There are in general, three options: Monitoring of small tumors (< 1cm in size) if hearing is still intact is an option in older patients and in younger patients with bilateral tumors associated with NF (Neurofibromatosis, NF-2). This includes clinical and hearing tests supplemented with regular MRI scans. If the tumor increases in size and significant hearing loss occurs treatment is recommended.

Surgery and tumor excision was once the only treatment option for most of the 20th century. Microsurgery, improved anesthesiology, Image-guidance , better microsurgical tools and nerve monitoring have improved the results of surgery. Microsurgery may still be the best treatment option for large tumors (>3.5cm) in selected patients who have symptoms from the mass effect of the tumor.

Radiosurgery is now an accepted treatment modality for acoustic neuromas as there is overall a lower risk than surgery in terms of anesthesia risks, bleeding and infection. Mortality which is a possibility with any brain surgery is extremely rare and even exceptional with modern radiosurgery/stereotactic radiotherapy. In addition numerous centers and clinical papers have documented the safety and effectiveness of Radiosurgery. Newer forms of radiosurgery include Micro-MLC radiosurgery, fractionated radiosurgery (also referred to as Stereotactic Radiotherapy and vice versa) and NeuroTomotherapy.

Combined Microsurgery and Radiosurgery (CMR) is an option that can work well with large acoustic neuromas. Microsurgery is used to remove tumor in a safe way without damaging near by nerves (especially the facial nerve and trigeminal nerve and the brainstem) and any remaining smaller volume tumor is then treated subsequently with radiosurgery / SRT / FSR / NeuroTomotherapy.

Slow down the aging process with this lifestyle for women

Tip 1: Use sun block
Aside from muscle motion, ultraviolet radiation (UV rays) contained in sunlight is also a cause of wrinkles and other signs of ageing to the skin. These rays have a number of harmful effects, including the break-down of collagen and elastin fibres and, over the years this damage leads to wrinkle formation, discolouration of the skin, poor skin texture and, in some cases, the formation of skin cancers. To protect against the effect of UV rays, you need to use a protective cream or lotion, at least SPF 30, every day.

Tip 2: Beat stress
Stress, whether physical or emotional, affects our hormonal systems and, as a consequence, increases inflammation at a cellular level. These prolonged periods of elevated hormones and inflammation, caused by stress, are damaging and can lead to premature ageing. For this reason it's important to minimise stress in our lives or, if this is not possible, learn to manage it.

Tip 3: Exercise regularly
Whether it's joining a gym, swimming, jogging or just brisk walking, any form of exercise keeps your body active and youthful. It improves the circulation, which delivers oxygen around the body, so we feel more energetic. It also helps keep our muscles toned, helping our bodies to stay youthful and attractive.

Tip 4: Get your beauty sleep
Sleep is a restorative process. It rejuvenates and energises the body and brain. Our immune systems are recharged. Cells grow and repair themselves, and our bodies conserve energy. What's more, sleep is simple and free. So get at least 7 to 8 hours each night of pure, uninterrupted sleep.

Tip 5: Eat healthy
Increase your intake of fresh fruit and vegetables. Strawberries, blueberries, grapefruit, oranges, spinach, broccoli and tomatoes are all great sources of youth-preserving vitamins and can help fight the damage caused by free radicals. Eat about 5 to 7 servings a day. Here are some examples of a single serving size: one medium-size piece of fruit, 3/4 cup of fruit or vegetable juice, one cup of raw, leafy vegetables or 1/4 cup dried fruit.

Tip 6: Stick to a beauty regimeS
tick to your morning and night-time beauty regime diligently. Every morning, use a cleanser, toner, and moisturiser with at least SPF 30 protection. At night SPF protection is not needed but it's advisable to choose a richer moisturiser. Think of these products as long-term maintenance for your skin.

Tip 7: Choose skin care products carefully
You may have to do a little research and experimentation to find the skin care products that best suits your skin. Some of the ingredients used in skincare products, such as alcohol and fragrances can be irritating for some skins. If you have any doubts or concerns about skincare products, consult a dermatologist.

Tip 8: Pre-empt ageing
Fine lines, crow's feet, dull skin and rough skin are subtle signs of ageing. You can nip them in the bud with the help of a doctor. Ask for advice from a qualified doctor about preventive and refining treatments.

Tip 9: Liquids, Liquids, Liquids
For your skin (and indeed your whole body) the most important liquid is water. It cleanses away cell waste, blood poisons and environmental toxins from the body. Besides plain water, drink plenty of freshly squeezed fruit juices, herbal teas and the occasional wheatgrass juice. Many natural juices and teas are rich in antioxidants which can help counteract the effects of ageing on your body.

Tip 10: Breathe properly
Learn to breathe deeply and calmly, instead of taking rapid sips of air. This will help you feel more relaxed and increase the amount of oxygen in your bloodstream, giving you more energy and increasing your mental focus. And you'll feel fresher too!

Sarawak: 1,336 rakyat dijangkiti wabak Aids

Sejumlah 187 rakyat Sarawak disahkan meninggal dunia kerana didapati menghidap Aids sejak 19 tahun lalu dengan 1,336 penduduk dikenal pasti dijangkiti penyakit maut itu.

Menteri Kewangan Kedua merangkap Menteri Alam Sekitar Sarawak, Datuk Seri Wong Soon Koh, yang bimbang dengan perkara itu, berkata terdapat peningkatan kes penyakit Aids yang dilaporkan di negeri setiap tahun.

Justeru, beliau berkata, usaha serius perlu dilakukan untuk membendung penularan wabak Aids di Sarawak.

Kita tidak mahu wabak berkenaan terus menular di Sarawak. Ketika ini, sejumlah 188,000 rakyat negara ini disahkan pembawa kuman HIV atau dijangkiti Aids.

"Perkara ini agak membimbangkan dan terdapatnya peningkatan kes seumpamanya di Sarawak," katanya ketika merasmikan Forum Bersama Membenteras Aids di Pustaka Miri