Live Acoustic Neuroma Surgery: Meet the Surgeons

Barrow neurosurgeon Dr. Randall Porter and neuro-otologist Dr. Mark Syms will perform a live acoustic neuroma surgery on Tuesday, May 8. We spoke to the physicians about why they chose this subspecialty, their philosophy of care, and the importance of taking a team approach to acoustic neuroma treatment.

An acoustic neuroma is a benign tumor that develops on the vestibulocochlear nerve, which carries sound and balance information from the inner ear to the brain. Because these tumors usually grow slowly and do not spread to other parts of the body, many of them never require surgery and instead are monitored with MRI scans and hearing and balance tests.

However, acoustic neuroma experts may recommend radiosurgery or open surgery for tumors that are growing rapidly, affecting hearing or balance, or compressing important structures such as the brainstem.

Treating Acoustic Neuroma: A Team Approach

When surgically treating an acoustic neuroma, a neurosurgeon will often work with a neuro-otologist.

“Acoustic neuroma surgeries have historically been done in what would be considered a team approach,” Dr. Syms said. “The reason is that the surgery involves multiple parts. There’s the bony removal, which is getting the approach to the tumor, and then the removal of the tumor.”

Dr. Porter said acoustic neuroma procedures can sometimes take up to 12 hours, making them grueling for one surgeon.

photo of phoenix neurosurgeon randall porter
Barrow Neurosurgeon Dr. Randall Porter

“I could do my own drilling, but I would just be exhausting myself unnecessarily,” he said.

After about 15 years of working together in the operating room, both Dr. Porter and Dr. Syms—who are co-directors of the Barrow Acoustic Neuroma Program—agree that a team approach yields better outcomes.

This philosophy doesn’t just apply to the operating room. Every week at Barrow, specialists in neurosurgery, neuro-oncology, radiation oncology, neuropathology, and neuroradiology meet to discuss brain tumor cases, including acoustic neuromas.

“If they feel you’ve made the wrong recommendation, they challenge you,” Dr. Porter said. “If there’s a weird twist to the case, they can help you and you can help them.”

Dr. Porter said having many different specialists in one location who see a high volume of acoustic neuroma patients sets Barrow apart from other centers. Having specialists in neuro-otology, as well as vestibular rehabilitation and neuro-rehabilitation, allows the program to provide a complete spectrum of care.

Why Acoustic Neuroma?

Dr. Syms underwent training for acoustic neuromas at the renowned House Clinic in Los Angeles, where he spent two years as a neuro-otology fellow. This followed five years of residency training in otolaryngology at the Tripler Army Medical Center in Hawaii. Otolaryngologists specialize in disorders of the ear, nose, and throat—earning the nickname “ENT doctors.”

“I’m essentially the ‘E’ of ENT,” he said. “Neuro-otology is a subspecialty where you specialize in disorders of the inner ear and the neurological pathway of the ear. Dealing with one of the sense organs, where you can restore and preserve hearing and treat disorders, took me in that direction.”

Barrow Neuro-otologist Dr. Mark Syms

As a neuro-otology fellow, he learned how to surgically approach and remove acoustic neuromas, as well as how to manage them. The combination of surgical and medical care is what initially drew Dr. Syms to the field.

Dr. Porter became interested in neurosurgery while doing a rotation at Barrow as a medical student. He worked under Dr. Robert Spetzler, an internationally recognized expert in cerebrovascular and skull base surgery.

After joining Barrow as a neurosurgery resident, Dr. Porter spent a week at the House Clinic to cultivate his interest in skull base surgery. He enjoyed the challenges associated with removing acoustic neuromas, such as preventing facial paralysis.

He completed a fellowship in cerebrovascular and skull base surgery during his chief residency year. To be able to treat acoustic neuromas with radiosurgery, he underwent training on the Gamma Knife system in Sweden and CyberKnife in Pittsburgh.

“I wanted to be able to look at my patients and offer any of the three options: observation, surgery, or radiation,” he said. “I think acoustic neuroma surgeons should do that so that they can objectively recommend the right treatment.”

Dr. Porter also enjoys that acoustic neuroma patients often become his patients for life, since many of them have their tumors monitored annually.

Philosophy of Care

Getting to know his acoustic neuroma patients aligns with his philosophy of care: treat patients like family members.

It’s about empowering patients to be able to chart the relatively confusing waters of determining which care option they would like to take.

-Dr. Mark Syms, Barrow Neuro-otologist

“When I go into a surgery for an acoustic neuroma, I say to myself: if this were my wife or daughter, what would I want to do?” He said. “Sometimes a surgery is not particularly going well, and you have to have the humility to back out. The most important thing is the patient wakes up the way you put them to sleep.”

Both Dr. Porter and Dr. Syms strive to educate their patients about the different treatment options and encourage patients to share in the decision-making.

“Patients are really what I would consider the captain of the ship, and I consider myself the co-captain,” Dr. Syms said. “It’s about empowering patients to be able to chart the relatively confusing waters of determining which care option they would like to take.”

To watch the live surgery, visit on Tuesday, May 8 at 8:30 AM Pacific Daylight Time. The surgery will also be recorded and available on demand.