Acoustic neuroma

To present the clinical features, the diagnostic methods, and the techniques and results of surgical removal of acoustic neuromas, and to illustrate the lowered mortality and morbidity derived from improved imaging and the improved surgical results from a teamwork approach.

We review our consecutive series of 106 patients undergoing 119 operations for acoustic neuroma at Royal Prince Alfred Hospital in Sydney between 1977 and 1988.

Forty-two operations were standard posterior fossa craniectomies. The mortality was 9.5%, preservation of facial nerve function was achieved in 48% of patients, and complete removal of tumour in 66% (42% of patients had a tumour larger than 3.5 cm). A translabyrinthine approach was used in 27 patients, with a mortality of 14% and no improvement in preservation of facial nerve function. The middle cranial fossa approach was used in six patients without mortality but with no better result in preservation of nerve function. The retrosigmoid approach was used in 44 patients with no mortality and preservation of facial nerve function in 86% of patients.

Improved imaging and earlier diagnosis have led to improved surgical results, both in terms of reduced mortality and morbidity and in the preservation of function, particularly of the facial nerve, and at times also of hearing (mostly in patients with small tumours). The surgical results have been substantially improved by the formation of a cohesive and effective neuro-otology team to perform this intricate and protracted surgery.