Radiosurgery in case of recurrent acoustic neuroma or: The smart solution of a surgical problem?

Background: Stereotactic radiosurgery has proved to be an effective alterna tive to microsurgical resection in treatment of acoustic neuroma. Still, mi crosurgery is considered by many to be the therapy of choice. In case of re currence microsurgical resection is much more difficult because of scarring and has a higher risk of complications. Therefore in cases of recurrence t he role of radiosurgery needed to be evaluated. Patients and Methods: From April 1992 to July 1997 135 patients suffering from acoustic neuroma were t reated at the Neurosurgical Department of the University Medical School of Graz by means of the gamma -knife. 12 patients had recurrence after a singl e or several microsurgical resections. The age distribution was between 38 and 71 years with a mean of 57 years. The diameter of the tumors varied bet ween 10.5 and 31.2 mm. Results: In all 12 cases the tumors could be inactiv ated biologically in a mean follow-up period of 58.8 months by means of ste reotactic radiosurgery. Tumor shrinkage was achieved in 3 cases (25 %), cen tral necrotic areas were observed in 8 cases (67 %). No additional cranial nerve palsies occurred. Conclusions: Stereotactic radiosurgery has proven t o be a safe and effective treatment option instead of repeated microsurgery . Stereotactic radiosurgery should be considered as the therapy of choice i n cases of recurrent acoustic neuromas.