BACKGROUND
The purpose of this study was to evaluate the results of surgery for small
acoustic neurinomas at our institute via the middle cranial fossa and retro
sigmoid approaches, and to determine the indications for each approach,
METHODS
Fifty-three patients with unilateral tumors less than 2 cm in diameter were
studied. Surgery was performed via the middle cranial fossa approach in 36
tumors and via the retrosigmoid approach in 17 tumors.
RESULTS
The hearing preservation rate was 68% (36/53) in all patients, 93% (14/15)
in patients with intracanalicular tumors, 79% (15/19) in patients with tumo
rs less than 1 cm in diameter, and 43% (7/19) in patients with tumors betwe
en 1 and 2 cm in diameter. The facial nerve function was excellent or good
in 80% (42/53), 74% (11/15), 84% (16/19), and 78% (15/19), respectively. Am
ong the 19 patients with tumors between 1 and 2 cm in diameter, the frequen
cies of hearing preservation and of excellent or good facial nerve function
(47% and 87%, respectively) in the 15 patients approached via the retrosig
moid approach were higher than those (0% and 50%, respectively) in the four
patients approached via the middle cranial fossa approach.
CONCLUSIONS
We conclude that tumors smaller than 2 cm should be removed because preserv
ation of hearing as well as facial nerve function may be possible in almost
all of these patients. Tumors larger than 1 cm should be surgically treate
d through the retrosigmoid approach. (C) 2000 by Elsevier Science Inc.