Acoustic neuromas in the elderly

Objective: To determine if an "observational protocol with serial scanning is a safe and effective management paradigm for acoustic neuromas in the el derly. Study Design: A retrospective case review was performed. Setting: This study was performed in an academic, tertiary care center. Patients: Forty-one patients over the age of 65 years were identified with the primary diagnosis of unilateral acoustic neuroma. without prior treatme nt or observation. Intervention: The patients were followed with serial, gadolinium-enhanced m agnetic resonance imaging (MRI) scans performed at 6 months and then yearly . if no significant growth occurred. Main Outcome Measures: The patients were monitored for tumor growth, crania l nerve deficits, and hydrocephalus. Results: The patients were followed for an average of 3.5 years (range, 6 m onths to 9 years). The average turner size at presentation was 1.14 cm, wit h a range of growth rates from 0 to 1.2 cm per year. Twenty-one patients de monstrated tumor growth at an average rate of 0.322 cm per year. Only five patients (12%) required further intervention. Three patients underwent tran slabyrinthine excision. and two patients were treated with radiation. No pa tients developed significant complications during the observation period. Conclusions: Acoustic neuromas in the older population can be managed safel y using serial MRI scanning. No correlation could be made between initial t umor size and subsequent growth rate.