Acoustic Neuroma: Surgical Perspective

For both the physician and the patient, the decision making for treatment options in acoustic neuroma has taken on more complexity. At least in experienced hands, surgical results have become highly commendable and provide a reasonable success rate to those looking for an excisional cure. Radiosurgical tumor control data, again in the best of hands, grows more impressive, now with 10 to 15 years of follow-up. Hypofractionated radiosurgery has a laudable safety record, although long-term efficacy data is lacking. In selected cases, simple observation is also an effective strategy. Clearly, there is not one best way to treat a patient with an acoustic tumor. In the ideal situation, a simple comparison between efficacy and safety data from several different therapeutic options should be sufficient to make a decision. However, besides the various treatment options that exist, other factors come into play, including patient preference, surgeon bias, cost, patient age, and lifestyle issues. Surgical excision of these tumors has been the traditional treatment for these tumors. In our practice, the roles of neurosurgical treatment and/or stereotactic radiosurgical treatment of acoustic neuromas depend on four factors: (1) patient age, (2) tumor size, (3) hearing levels, and (4) recurrence.