CYSTIC ACOUSTIC NEUROMAS - RESULTS OF TRANSLABYRINTHINE SURGERY

Objective: This study was designed to investigate the surgical outcome of translabyrinthine surgery of cystic acoustic neuromas. Design: Pro spective registration of audiovestibular, otoneurologic, and neuroradi ologic data of all patients operated on for cystic neuromas in the per iod 1976 to 1992. The diagnosis was proposed by neuroradiologic invest igation, confirmed at surgery, and verified histologically. Clinical f ollow-up was performed 1 year after surgery. Setting: The study includ ed all patients with cystic acoustic neuromas from the entire country, referred to the centralized otoneurosurgical team in the Department o f Otorhinolaryngology-Head and Neck Surgery, Gentofte University Hospi tal, and Department of Neurosurgery, Rigshospitalet, University of Cop enhagen, Denmark. Patients: The study included 23 patients (11 female and 12 male). Ages ranged between 23 and 77 years with a median of 51. 2 years. Main Outcome: Our hypothesis suggested that surgical outcome of cystic acoustic neuromas was poorer compared with noncystic acousti c neuromas of matching size. The results of this study seem to confirm the hypothesis. Results: The results are rather poor compared with re sults achieved in surgery of noncystic tumors of matching size, partic ularly the poor postoperative facial nerve function. Conclusions: Even though the operation for a cystic acoustic neuroma may appear to be e asier and faster than the operation for a solid tumor, there is a high risk for accidental lesion of the facial nerve, in spite of using fac ial nerve monitoring. Rapid symptomatic worsening may occur due to sud den expansion of cystic elements and, therefore, a wait-and-see policy should not be applied to patients with cystic tumors.