Characteristics of Intracanalicular Acoustic Neuromas

An intracanalicular acoustic neuroma is <1 cm in length and appears rounded in the early stages. Upon filling the internal auditory canal (IAC), it assumes an oblong shape. At diagnosis, three variations are encountered, depending on the extent of involvement of the IAC: (1) medial IAC location near the porus acousticus, (2) lateral IAC involvement near the fundus, and (3) involvement of the entire IAC. True intracanalicular tumors involve only the IAC, although many tumors can be considered "primarily" intracanalicular with minimal cerebellopontine angle extension, and are readily accessible by surgical approaches to the IAC. It should be noted that whereas 90% of intracanalicular lesions are indeed acoustic neuromas, patients should be counseled regarding the possibility that a facial neuroma may be radiologically indistinguishable from an acoustic neuroma.2 Alternative management schemes in the event of the presence of a facial neuroma should be discussed preoperatively with the patient.

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