Download PDF
Skull Base 2006; 16(2): 095-100
DOI: 10.1055/s-2006-934112
ORIGINAL ARTICLE

Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Conservative Management of Acoustic Neuroma

Abdulrahman Al Sanosi1 , Paul A. Fagan2 , Nigel D.W Biggs2
  • 1Department of Otolaryngology, King Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia
  • 2Department of Otolaryngology/Skull Base Surgery, St. Vincent Hospital, Darlinghurst, Sydney, Australia
Further Information

Publication History

Publication Date:
01 April 2006 (online)

    Permissions and Reprints

ABSTRACT

Aim of study: To identify those patients with vestibular schwannoma (acoustic neuroma) in whom treatment becomes necessary. Method: Retrospective chart review. Result: A total of 205 patients with small tumors were followed for a mean of 40.8 months. The longest follow-up was 180 months. One hundred and ninety-seven patients had a follow-up of more than 12 months. Eight patients with a follow-up of less than 12 months were excluded from the study. In 136 patients (66.3%) the tumor did not grow. Forty-seven patients (23.9%) showed some evidence of slow growth. Eight of 197 patients (4%) had rapid growth and 6 patients (3%) had radiological evidence of tumor regression. Fifteen patients came to surgery. Five of these showed rapid growth, four developed ataxia in whom tumor growth was slow, three had ataxia without tumor growth, two patients developed brainstem compression, and one patient elected to proceed to surgery, although there were no tumor growth or symptoms. Conclusion: Few patients with small tumors will come to surgery in the short term. Perhaps the majority of patients with such small tumors will not need surgery. Long-term follow-up studies of 20 years or more are required to be come more confident about the natural history of these tumors. This study continues.

KEYWORDS

Acoustic neuroma - cerebellopontine angle - magnetic resonance imaging - nonsurgical management

REFERENCES

  • 1 Lanser M J, Sussman S A, Frazer K. Epidemiology, pathogensis, and genetics of acoustic tumors.  Otolaryngol Clin North Am. 1992;  25 499-520
    PubMedGoogle Scholar
  • 2 Nedzelski J M, Schessel D A, Pfleiderer A, Kassel E E, Rowed D W. Conservative management of acoustic neuromas.  Otolaryngol Clin North Am. 1992;  25 691-705
    PubMedGoogle Scholar
  • 3 Silverstein H, McDaniel A, Norrell H, Wazen J. Conservative management of acoustic neuroma in the elderly patient.  Laryngoscope. 1985;  95 766-770
    PubMedGoogle Scholar
  • 4 Strasnick B, Glasscock 3rd M E, Haynes D, McMenomey S D, Minor L B. The natural history of untreated acoustic neuromas.  Laryngoscope. 1994;  104 1115-1119
    PubMedGoogle Scholar
  • 5 Rosenberg S I, Silverstein H, Gordon M A, Flanzer J M, Willcox T O, Silverstein J. A comparison of growth rates of acoustic neuromas: non-surgical patients vs. subtotal resection.  Otolaryngol Head Neck Surg. 1993;  109 482-487
    PubMedGoogle Scholar
  • 6 Wazen J, Silverstein H, Norrell H, Bessc B. Preoperative and postoperative growth rates in acoustic neuromas documented with CT scanning.  Otolaryngol Head Neck Surg. 1985;  93 151-155
    PubMedGoogle Scholar
  • 7 Silverstein H, Rosenberg S I, Flanzer J M, Wahamaker H H, Seidmen M D. An algorithm for the management of acoustic neuromas regarding age, hearing, tumor size, and symptoms.  Otolaryngol Head Neck Surg. 1993;  180 1-10
    PubMedGoogle Scholar
  • 8 Nedzelski J M, Canter R J, Kassel E E, Rowed D W, Tator C H. Is no treatment good treatment in the management of acoustic neuromas in the elderly?.  Laryngoscope. 1986;  96 825-829
    PubMedGoogle Scholar
  • 9 Nedzelski J M, Schessel D A, Pfleiderer A, Kassel E E, Rowed D W. Conservative management of acoustic neuromas.  Otolaryngol Clin North Am. 1992;  25 691-705
    PubMedGoogle Scholar
  • 10 Jørgensen B G, Pedersen C B. Acoustic neuroma. Follow-up of 78 patients.  Clin Otolaryngol Allied Sci. 1994;  19 478-484
    PubMedGoogle Scholar
  • 11 Martin C, Martin H, Portafaix M, Saby J L. De la particulière lenteur dévolution de certains neurinomes de l'acoustique [peculiarly slow development of several acoustic neuromas. Management.]  Ann Otolaryngol (Chir Cervicofac). 1985;  102 19-29
    PubMedGoogle Scholar
  • 12 Wazen J, Silverstein H, Norrell H, Besse B. Preoperative and postoperative growth rates in acoustic neuromas documented with CT scanning.  Otolaryngol Head Neck Surg. 1985;  93 151-155
    PubMedGoogle Scholar
  • 13 Clark W C, Moretz Jr W H, Acker J D, Gardner L G, Eggers F, Robertson J H. Nonsurgical management of small and intracanalicular acoustic tumors.  Neurosurgery. 1985;  16 801-803
    PubMedGoogle Scholar
  • 14 Laasonen E M, Troupp H. Volume growth rate of acoustic neurinomas.  Neuroradiology. 1986;  28 203-207
    CrossrefPubMedGoogle Scholar
  • 15 Gardner G, Moretz Jr W H, Robertson J H, Clark C, Shea Jr J J. Nonsurgical management of small and intracanalicular acoustic tumors.  Otolaryngol Head Neck Surg. 1986;  94 328-333
    PubMedGoogle Scholar
  • 16 Kassel E E, Nedzelski J M, Canter R J, Rowed D W, Cooper P W. Radiologic assessment of acoustic neuroma in the elderly: Is no treatment good treatment?.  Acta Radiol Suppl. 1986;  369 182-185
    PubMedGoogle Scholar
  • 17 Thomsen J, Tos M. Acoustic neuromas. Diagnostic delay, growth rate and possible non-surgical treatment.  Acta Otolaryngol Suppl. 1988;  452 26-33
    PubMedGoogle Scholar
  • 18 Valvassori G E, Guzman M. Growth rate of acoustic neuromas.  Am J Otol. 1989;  10 174-176
    PubMedGoogle Scholar
  • 19 Wiet R J, Young N M, Monsell E M, O'Connor C A, Kazan R. Age considerations in acoustic neuroma surgery: the horns of a dilemma.  Am J Otol. 1989;  10 177-180
    PubMedGoogle Scholar
  • 20 Thomsen J, Tos M. Acoustic neuroma: clinical aspects, audiovestibular assessment, diagnostic delay, and growth rate.  Am J Otol. 1990;  11 12-19
    PubMedGoogle Scholar
  • 21 Bederson J B, von Ammon K, Wichmann W W, Yasargil M G. Conservative treatment of patients with acoustic tumors.  Neurosurgery. 1991;  28 646-650
    CrossrefPubMedGoogle Scholar
  • 22 Anand V T, Kerr A G, Byrnes D P, Smyth G D. Non-surgical management of acoustic neuromas.  Clin Otolaryngol Allied Sci. 1992;  17 406-410
    PubMedGoogle Scholar
  • 23 Strasnick B, Glasscock 3rd M E, Haynes D, McMenomey S O, Minor L B. The natural history of untreated acoustic neuromas.  Laryngoscope. 1994;  104 1115-1119
    PubMedGoogle Scholar
  • 24 Wiet R J, Zappia J J, Hecht C S, O'Connor C A. Conservative management of patients with small acoustic tumors.  Laryngoscope. 1995;  105 795-800
    PubMedGoogle Scholar
  • 25 Charabi S, Thomsen J, Mantoni M et al.. Acoustic neuroma (vestibular schwannoma): growth and surgical and nonsurgical consequences of the wait-and-see policy.  Otolaryngol Head Neck Surg. 1995;  113 5-14
    PubMedGoogle Scholar
  • 26 Deen H G, Ebersold M J, Harner S G et al.. Conservative management of acoustic neuroma: an outcome study.  Neurosurgery. 1996;  39 260-264 , discussion 264-266
    CrossrefPubMedGoogle Scholar
  • 27 Levo H, Pyykkö I, Blomstedt G. Non-surgical treatment of vestibular schwannoma patients.  Acta Otolaryngol Suppl. 1997;  529 56-58
    PubMedGoogle Scholar
  • 28 Yamamoto M, Hagiwara S, Ide M et al.. Conservative management of acoustic neurinomas: prospective study of long-term changes in tumor volume and auditory function.  Minim Invasive Neurosurg. 1998;  41 86-92
    PubMedGoogle Scholar
  • 29 Niemczyk K, Vaneecloo F M, Lemaitre L et al.. The growth of acoustic neuromas in volumetric radiologic assessment.  Am J, Otol. 1999;  20 244-248
    PubMedGoogle Scholar
  • 30 Mirz F, Jørgensen B, Fiirgaard B, Lundorf E, Pedersen C B. Investigations into the natural history of vestibular schwannomas.  Clin Otolaryngol Allied Sci. 1999;  24 13-18
    PubMedGoogle Scholar
  • 31 Smouha E E, Yoo M, Mohr K, Davis R P. Conservative management of acoustic neuroma: a meta-analysis and proposed treatment algorithm.  Laryngoscope. 2005;  115 450-454
    CrossrefPubMedGoogle Scholar
  • 32 Long S A, Arriaga M, Nelson R A. Acoustic neuroma volume: MRI-based calculations and clinical implications.  Laryngoscope. 1993;  103 1093-1096
    PubMedGoogle Scholar
  • 33 Fiirgaard B, Pedersen C B, Lundorf E. The size of acoustic neuromas: CT and MRI.  Neuroradiology. 1997;  39 599-601
    CrossrefPubMedGoogle Scholar
  • 34 Monsell E M, Cody D D, Spickler E, Windham U P. Segmentation of acoustic neuromas with magnetic resonance imaging and Eigen image filtering.  Am J Otol. 1997;  18 602-607
    PubMedGoogle Scholar
  • 35 Toner J G, Smyth G D. Comparison of methods of evaluating benefit of middle ear surgery.  J Laryngol Otol. 1993;  107 4-5
    PubMedGoogle Scholar
  • 36 Browning G G, Gatehouse S, Swan I R. The Glasgow Benefit Plot: a new method for reporting benefits from middle ear surgery.  Laryngoscope. 1991;  101 180-185
    PubMedGoogle Scholar

Paul A FaganM.D. 

352 Victoria S., Darlinghurst NSW 2010, Australia

Email: pfagan@pfagan.com.au

      >