MANAGEMENT OF ACOUSTIC NEUROMA IN THE ELDERLY POPULATION

Objective: Ongoing controversy regarding the optimal treatment of acou stic neuromas in the elderly population has prompted us to examine the our experience in order to arrive at a treatment algorithm. Study Des ign: Retrospective case review. Setting: Tertiary referral center. Pat ients: The records of 48 elderly patients ranging from age 70 to 90 ye ars with acoustic tumors were reviewed. Interventions: In 34 cases, tu mor size was followed through serial imaging for a mean 28.5 months (r ange 5-108 months). Eight of these patients subsequently required surg ery for significant tumor growth. An additional 12 patients were manag ed surgically from the time of diagnosis. Main Outcome Measure: The na tural history of acoustic neuromas in the elderly population. Results: The mean tumor growth rate for the watched group was 0.29 cm/y. Fifte en patients demonstrated no growth whereas accelerated growth was note d in eight cases. Ten patients with tumors confined to the internal au ditory canal demonstrated an average growth rate of only 0.06 cm/y ove r a mean interval of 38 months. For the surgically treated group, the mean tumor size at the time of resection was 2.8 cm. Resection was des cribed as complete in 17 cases and near-total in three cases. Perioper ative complication rates and facial nerve results were comparable to o ur figures for all age groups. There was one perioperative death. Conc lusions: Elderly patients with small acoustic neuromas should be offer ed a trial of observation. When significant tumor growth, size, or neu rologic deterioration are demonstrated, early surgical intervention is required to avoid complications associated with the removal of larger tumors.