Suboccipital resection of a medial acoustic neuroma with hearing preservation

BACKGROUND Many reports indicate that acoustic neuromas greater than 2.0 cm should be removed without hearing preservation attempted, even if hearing is present preoperatively. These studies advocate a translabyrinthine appro ach because the likelihood of hearing preservation is low. Medial acoustic neuromas, unlike the more common lateral tumors that involve the internal a uditory canal, originate medial to that portion of the eighth nerve complex where the cochlear and vestibular nerves are fused. This anatomical featur e suggests that these tumors may be amenable to resection with hearing pres ervation. METHODS A patient with a 3.5 cm medial acoustic neuroma and useful preopera tive hearing is presented. RESULTS Gross total tumor removal with functional hearing was achieved afte r a two-stage procedure using a suboccipital approach. CONCLUSION Based on the anatomico-pathologic features in this case, we beli eve that, if a patient has reasonable preoperative hearing (speech discrimi nation score > 70%) and a medial acoustic neuroma, an approach to preserve hearing should be considered regardless of tumor size. (C) 1999 by Elsevier Science Inc.