Historia magistra vitae (Cic. De or. 2.36). The Prime Objective of Radiosurgery in Acoustic Neurinomas

The central question of stereotaxic radiosurgery in acoustic neurinomas is how to pinpoint its main objective: is it a better alternative to neurosurgery or an option when surgery is unfeasible? This study is a continuation of the article published in 1995 in Acta Neurochirurgica, but benefits from greater experience, more complete analysis and longer supervision of results. The conclusions that can be drawn to date from our own findings and from others in the literature are the following: radiosurgery can be used not only to prevent neurinoma growth and at the same time to preserve the patient's neurological conditions without the risk of complications, but it can also be counted on to provide a cure. However, radiosurgery as an excising device is more insidious than the microsurgical scalpel, since the narrow beam of radiation, directed to a limited target without opening the skull, is invisible. The expression coined by Lars Leksell regarded precisely the innovation he himself conceived in the 'closed skull operation', with reference to its use in cases of acoustic neurinoma as an alternative to traditional surgery. Hence, whatever technique or instruments are involved, it is always a question of interventional neuroradiology or minimally invasive neurosurgery.