Management of Cystic Acoustic Neuroma

Objective To report clinical features and surgical outcomes of cystic acoustic neuroma (CAN). Methods A retrospective clinical analysis was conducted on 36 patients with CAN managed from January 2001 to December 2010. The clinical features and surgical outcomes were compared between these 36 cases of CAN and 79 cases of large or giant solid acoustic neuroma (SANs). Results In the 36 cases of CAN, the total, near-total and subtotal resection rates were 77.8%, 16.7% and 5.6%, respectively. The rate of intraoperative anatomical facial nerve (FN) preservation was 77.8%. The rate of long-term good FN function was 25.0%. A comparison between CAN and SAN cases showed several special clinical features with the former: shorter duration of symptoms, more severe clinical symptoms, higher near-total removal rate, lower anatomical FN preservation rate, higher rate of FN disruption, and poorer recovery of FN function. Conclusions CAN is considered being more aggressive than SAN with more rapid growth and worse symptoms. Surgical resection is the first choice management for CAN, but surgical outcomes may not be unsatisfactory. We recommend near total or subtotal resection in the case of peripheral thin-walled cystic tumors to protect the FN and reduce complications.