ACOUSTIC NEUROMAS - RESULTS OF CURRENT SURGICAL-MANAGEMENT

OBJECTIVE: In this article, we review the surgical outcomes of 179 pat ients with acoustic neuromas. METHODS: Most of the tumors (84%) were o perated on using a retrosigmoid, transmeatal approach. A transpetrosal , retrosigmoid approach was used in 10% of the patients, most of whom had large tumors. The translabyrinthine (4%) and transmastoid, transpe trosal, partial labyrinthectomy approaches (2%) were used selectively. The operative approaches are discussed. Tumors were categorized accor ding to their cerebellopontine angle dimensions as small (<2 cm), medi um (2.0-3.9 cm), and large (greater than or equal to 4 cm). RESULTS: H ouse-Brackmann evaluation of postoperative facial nerve function revea led excellent results (Grade I or II) in 96% of small tumors, 74% of m edium tumors, and 38% of large tumors. A fair postoperative function ( Grade III or IV) was achieved in 4% of small tumors, 26% of medium tum ors, and 58% of large tumors. Functional hearing preservation, defined as Gardner-Robertson Class I or II, was achieved in 48% of small tumo rs and 25% of medium tumors. Hearing was not preserved in any of the t hree patients with large tumors in whom hearing preservation was attem pted. Treatment complications consisted mainly of cerebrospinal fluid leakage (15% of the patients). The majority of the patients who experi enced cerebrospinal fluid leakage were treated successfully with lumba r spinal drainage; only four patients (2% of the total group) required subsequent surgery for correction of cerebrospinal fluid leakage. The re were two deaths (1%) in this series. One death occurred as the resu lt of myocardial infarction and the other as the result of severe obst ructive lung disease. One patient sustained disability because of cere bellar and brain stem injury. Complete tumor resection was accomplishe d in 99% of the patients, and there was no evidence of recurrence in t his group. Only 1 of the 179 patients underwent incomplete tumor resec tion; he required subsequent surgery for symptomatic tumor regrowth. O ur patient follow-up had a mean duration of 70 months and a median of 65 months (range, 3-171 mo). CONCLUSION: Our results are similar to th ose of other large microsurgical series of acoustic neuromas. Unless a patient has major medical problems, microsurgery by an experienced te am of surgeons is preferred over radiosurgery.