Management of acoustic neuromas.

A survey of the management of acoustic neuromas in the broadest sense is given. The epidemiology and pathogenesis is described. The clinical development may take any imaginable course, and even though a slowly progressing unilateral hearing impairment, of the sensorineural type, is the main pattern of presentation, it is stressed that any type of symptom could appear in an acoustic neuroma patient. In order to make an early diagnosis a high index of suspicion must be the basic principle, with all patients with unilateral symptoms, not only hearing deficits, being suspected of suffering from acoustic neuromas until proven otherwise. All patients with hearing better than 70-80 dB should be subjected to ABR, and if there is any doubt about the normality of the response, the patient should proceed to MRI. Patients with poor hearing should go directly to MRI. The advantages and disadvantages of the different surgical approaches are described and an electric treatment algorithm is outlined: 1) All tumors measuring 25 mm or more on MRI are operated via the translabyrinthine approach. 2) All patients with PTA poorer than 30 dB, and SDS poorer then 70% are operated via the translabyrinthine approach. 3) Tumors less than 10 mm extrameatally, and PTA better than 30 dB and SDS better then 70% are removed via the middle fossa route. 4) Tumors measuring 10-25 mm and PTA better than 30 dB and SDS better than 70% are removed via the suboccipital route.