[Acoustic neuroma. A review of 50 cases]

A consecutive series of 50 patients undergoing acoustic neurinoma excision between 1985 and 1990 is reported. All patients were operated by the retrosigmoid approach. With no mortality, the most frequent complication was a leak of cerebrospinal fluid (12%). The facial nerve was preserved in 94% of cases and the cochlear nerve in 38% of cases. In our series, the size of the neurinoma is the most important predictive factor for the post-operative facial nerve function. The cochlear nerve could be preserved in 19 patients but only 4 patients retain some hearing after surgery, which represents 8% of the whole series and 21% of the preserved cochlear nerves. 4 patients had a subtotal excision. All 4 had a grade IV neurinoma. Only one patient had a recurrence that necessitated a second surgery. Complete excision is the goal in acoustic neurinoma surgery. However the dilemma can sometimes arise between a complete removal necessitating the sacrifice of the facial nerve and a subtotal extirpation with regular control CT-scans in the follow-up.