Acoustic neuromas: management of 204 cases.

This paper reviews the author's personal experience with the management of 204 patients with the clinical diagnosis of acoustic neuroma. Craniotomy was performed in 181 of these cases, all of whom were proven to have acoustic neuromas. The remaining 23 cases with the clinical diagnosis of acoustic neuroma did not have tumour surgery, mainly because of advanced age or concurrent disease, although some required shunts for hydrocephalus. The management of acoustic neuromas including the selection of surgical approach depends upon the patient's age and general health, the size and growth direction of the tumour, previous surgical attempts at removal, and the presence of hydrocephalus, a contralateral tumour, and serviceable hearing. Twenty-nine other cases with the clinical diagnosis of acoustic neuroma underwent craniotomy: 20 had petrous or tentorial meningiomas encroaching on the porus acousticus or growing in the internal auditory canal, six had neuromas of the seventh cranial nerve and three had arachnoiditis occluding the internal auditory canal.