OUTCOME ANALYSIS OF ACOUSTIC NEUROMA MANAGEMENT - A COMPARISON OF MICROSURGERY AND STEREOTAXIC RADIOSURGERY

CURRENTLY, MICROSURGICAL RESECTION of acoustic neuromas by an experien ced, multidisciplinary team is thought to be the treatment of choice, During the past 20 years stereotactic radiosurgery has been used as an alternative to surgical removal. To compare the results of both micro surgery and stereotactic radiosurgery, we conducted a study of 87 pati ents with unilateral, previously unoperated acoustic neuromas with an average diameter less than 3 cm treated by the neurosurgical service d uring 1990 and 1991. Preoperative patient characteristics and average tumor size were similar between the treatment groups. State of the art microsurgical or radiosurgical techniques were used by experienced su rgeons in both treatment groups. The treatment groups were compared ba sed on cranial nerve preservation, tumor control, postoperative compli cations, patient symptomatology, length of hospital stay, total manage ment charges, effect on employment status, and overall patient satisfa ction. Stereotactic radiosurgery was more effective in preserving norm al postoperative facial function (P<0.05), and hearing preservation (P <0.03) with less treatment associated morbidity (P<0.01). Effect on pr eoperative symptoms were similar between the treatment groups. Postope rative functional outcomes rand patients' satisfaction of their tumor management were greater after stereotactic radiosurgery when compared to the microsurgical group, although they did not reach statistical si gnificance (P=0.07 and P=0.10, respectively). Patients returned to ind ependent functioning sooner after stereotactic radiosurgery (P<0.001). Hospital length of stay and total management charges were less in the radiosurgical group (P<0.001). When compared to microsurgical removal , stereotactic radiosurgery proved to be an effective and less costly management strategy of unilateral acoustic neuromas less than 3 cm in diameter. For many acoustic neuroma patients, stereotactic radiosurger y should be offered as an alternative management strategy.