Stereotactic radiosurgery in cases of acoustic neurinoma: further experiences.

Fourteen patients with acoustic neurinomas varying in size from 7 to 30 mm were treated by stereotactic radiosurgery and then were followed for 4 years. The tumors of eight patients decreased 1 to 10 mm in diameter, no change was found in two, and the tumor increased slightly in three patients. Loss of the ability to enhance with contrast administration on computed tomographic scan was a common effect of the treatment. One patient in poor general condition died from intercurrent disease 6 months after radiosurgery. At postmortem examination, a large central necrosis was found. Among five patients with hearing before treatment, full preservation was demonstrated in one; in the other four, the mean impairment of speech discrimination score was 43%. One patient with total unilateral deafness regained hearing and achieved a discrimination score of 60% at 1 year after treatment. There was transient facial weakness in five patients, which was detectable only by electromyography in one. Facial hypesthesia appeared in two patients and was transitory in one of them. Thirteen of the patients are in good or excellent general condition. Stereotactic radiosurgery offers the only therapeutic alternative to open operation in the management of acoustic neurinomas. It is worth considering for every patient, but especially for poor risk patients and those with bilateral tumors.