Dr Maniker did wish to express that though he has contact information online, any medical questions relayed directly to him would require an appointment and direct consultation. Something of an exception was made for our group as he wanted to be of service in helping us and others understand their Schwannomas and treatments. So if you wish to have your specific case reviewed in any way, please contact his office for a consultation.
Here is the Q and A, and we thank Dr. Maniker for his time and graciousness…his answers to the questions are in blue.
1) Several people on our page have mentioned that it had been discovered that they had a Schwannoma, but that some physicians that they have consulted have insisted that the Schwannoma is NOT the source of their pain. (One gentleman recently had this very thing happen. He has a Schwannoma in the psoas muscle and is showing symptoms of pain and weakness). Can you offer any suggestions, from a surgeon’s perspective, as to what may be the prudent course of action if a patient finds that they are left with such differing opinions from the physicians they consult?
Be very sure that the surgeon you have consulted has experience with peripheral nerve sheath tumors, if not, seek one out. If there are differing opinions then consult up to 3 or 4 surgeons to see if there is a consensus that emerges.
2) We have a person on the page who has been diagnosed with a Schwannoma (acoustic neuroma), and they have lost most of the hearing in their right ear. They have been told to go home and enjoy life – however the person is very worried because no biopsy has been performed. The person would like to know what are some of the criteria for making the determination that the patient has a Schwannoma (not cancer or another tumor) when no biopsy has been performed?
The criteria for identification of acoustic neuroma are primarily clinical and radiographic, i.e. the way the tumor appears on the MRI. The possibilities of types of tumors in the location of an acoustic neuroma are relatively few and generally benign and therefore no biopsy can often be justified. The individual should discuss his concerns with his surgeon directly.
3) Is there such a thing as a stagnant, non-growing Schwannoma? Every indication that I have heard (this is Neil, the page coordinator writing) is that though they exhibit different growth rates and require monitoring – that the overall tendency is for them to grow. Can you shed any light on how Schwannomas grow…if they are ever known to stagnate, and if you also if you validate the trend that has been expressed to me by several physicians – that Schwannomas have an overall tendency to grow?
Anything can do anything is a saying we have. Some schwannoma may grow; some may stay stable in size. In the peripherally located schwannoma (i.e. not an acoustic neuroma) if there is enlargement one must be concerned for malignant transformation (i.e. changing from benign to malignant) which is a rare occurrence but an indication for removal of the tumor.
4) Is Schwannomatosis a common diagnosis among Schwannoma patients that you have treated? Though we understand that you can’t speak for all cases whatsoever – could you put an estimation on what percentage of your Schwannoma patients that you have seen in your career were believed to have Schwannomatosis? Also can you shed any light on the number of Schwannoma patients you have seen that have only one tumor, and no recurrence?
Schwannomatosis is a rare, genetic condition. I have seen a handful of such patients, keeping in mind that it was only described as a condition in the mid 1990’s. By far the majority of schwannoma are isolated single occurrences
5) We have a person on the page who learned that during surgery for the removal of a Schwannoma in their arm, that the nerve was stretched and in the period of recovery after surgery the person has had tremendous pain. Can you suggest any advice for that person – who is currently trying very hard to rehab from the surgery, but pain is intense and proving to be a large obstacle?
Generally such pain is treated medically with something such as Neurontin. The patient should be evaluated by a pain management specialist if this medical treatment is unsuccessful.
*Disclaimer: Dr. Maniker and Beth Israel Medical Center assume no liability whatsoever for the comments or advice offered in the content of this blog. Dr. Maniker has offered his advice generally on the issues relating to treatment of Schwannomas - however Dr Maniker and the Schwannoma Survivors & Schwannoma Fighters group always insist that a person should make all major medical decisions in consultation with one's own physician.
