A COMPARISON OF GROWTH-RATES OF ACOUSTIC NEUROMAS - NONSURGICAL PATIENTS VS SUBTOTAL RESECTION

A conservative approach to the management of acoustic neuromas in elde rly patients has been used since 1971. Elderly patients without sympto ms of brain stem compression are initially treated by observation and yearly radiographic imaging. A translabyrinthine radical-subtotal rese ction is performed if brain stem compression is present or if tumor is growing rapidly. Twenty-three patients, ages 65 to 86 years, had init ial nonsurgical management of their tumors. Growth rates could be dete rmined for 16 patients. Thirteen patients not requiring surgery had an average tumor growth rate of 0.6 mm/yr. Three patients with an averag e growth rate of 6.8 mm/yr eventually required surgery. No patient who se tumor was < 15 mm at initial evaluation has experienced brain stem symptoms or demonstrated rapid tumor growth. Twenty-four patients ages 65 to 86 years underwent planned subtotal tumor excision. Eighteen pa tients followed postoperatively for more than i year demonstrated an a verage rate of regrowth of tumor of 0.7 mm/yr.