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The treatment of small acoustic tumors: now or later?
1House Ear Institute, Los Angeles, Calif.
Abstract:
Prior to the advent of microneurosurgery, the operative mortality for acoustic tumor removal was high and management often consisted of observation until sufficient symptoms warranted removal. The treatment of these tumors has evolved, and recent introduction of gadolinium-enhanced magnetic resonance imaging (MRI) allows the diagnosis of very small intracanalicular acoustic tumors before hearing has been significantly affected. For such tumors, some surgeons advocate the premicrosurgical philosophy of observation rather than removal. Our results of small acoustic tumor removal with attempt at hearing preservation were reviewed. From 1961 to June 1989, 39 acoustic tumors 0.5 cm or less were removed by the middle fossa approach. Measurable hearing was preserved in 67%, and facial function 1 year postoperatively was normal or nearly normal in 97%. There was no other permanent operative morbidity. Given our results, early surgical removal of small acoustic tumors is advocated.
Insights
Early surgical removal of small acoustic tumors is recommended. This approach preserves hearing in 67% and maintains normal facial function in 97% of patients, with no permanent operative morbidity.
Area of Science:
- Neurosurgery
- Otolaryngology
- Neurology
Background:
- Acoustic tumors (vestibular schwannomas) historically had high mortality with surgical removal.
- Management evolved from observation to surgical intervention as diagnostic tools improved.
- Gadolinium-enhanced MRI enables early detection of small, intracanalicular tumors, prompting debate on observation versus early removal.
Purpose of the Study:
- To review outcomes of early surgical removal for small acoustic tumors (≤0.5 cm).
- To assess hearing preservation and facial nerve function after middle fossa acoustic tumor removal.
- To advocate for early surgical intervention based on favorable results.
Main Methods:
- Retrospective review of 39 acoustic tumors removed via middle fossa approach between 1961 and June 1989.
- Tumors measured 0.5 cm or less.
- Assessment of hearing preservation and facial nerve function at 1 year postoperatively.
Main Results:
- Measurable hearing was preserved in 67% of patients.
- Normal or near-normal facial function was achieved in 97% of patients at 1 year.
- No permanent operative morbidity was reported.
Conclusions:
- Early surgical removal of small acoustic tumors is advocated.
- The middle fossa approach facilitates hearing preservation and excellent facial nerve outcomes.
- Favorable results support proactive surgical management of incidentally discovered small acoustic tumors.