The Intracanalicular Acoustic Neuroma

"We believe that patients with intracanalicular tumors who represent good candidates for treatment should be addressed surgically at the time of diagnosis. This is supported by the findings of the National Institutes of Health Consensus Development Conference in 1994: the ideal treatment of acoustic tumor is total surgical excision of the tumor in a single stage, with preservation of neurologic function."

Derald E. Brackmann

"During the past 10 years, the long-term safety and efficacy of stereotactic radiosurgery have established this technique as an important noninvasive first-line alternative to microsurgery. The absence of procedure-related mortality and morbidity and superior tumor control, hearing, and facial preservation rates, favor radiosurgery as the first management choice for patients with intracanalicular acoustic neuromas."

L. Dade Lunsford

"The role of the auditory brainstem response audiometry as a screening tool has been the subject of considerable discussion. For patients with intracanicular tumors, the sensitivity of ABR is highly suspect and the specificity poor. Many neurotologists (including the present author) are concerned about the low sensitivity and generally omit the ABR. Others counter that the ABR is widely available, less expensive, and likely to miss only small tumors that are not a threat to the patient."

Stephen G. Harner

The Intracanalicular Acoustic Neuroma

Derald E. Brackmann, Robert M. Owens, and Jose N. Fayad

CHAPTER 49

The management of acoustic tumors has become more complex through the years with the availability of multiple therapeutic options. Because of the relative limitations of early imaging techniques, most tumors were discovered only after they had grown to considerable size. During the 1970s, the development of computed tomograph (CT) air cisternography scanning permitted more accurate diagnosis of acoustic tumors. Advances in neuroradiology during the 1980s, specifically the advent of gadolinium-enhanced magnetic resonance imaging (MRI), led to earlier diagnosis of tumors. The use of MRI permits the detection of small intracanalicular tumors in patients with minimal early symptoms and represents the gold standard method for diagnosis. In addition, heightened clinical suspicion by otolaryngologists and primary care physicians attributable to an increased awareness of early symptoms has contributed to the earlier screening and eventual diagnosis of patients with tumors.

The increase in diagnosis of tumors at an early growth stage has led to controversy over management strategies. In 1994, the National Institutes of Health Consensus Development Conference determined that the treatment of patients with acoustic neuroma should be provided by an experienced multidiscipli-nary team and individualized with regard to tumor and patient characteristics.1 The individualized approach is applicable, in particular, to the management of a patient with an intracanalicular tumor. The therapeutic options available in the management of these patients include surgery, stereotactic radiotherapy, and close observation with serial MRI. The discussion in this chapter assumes a unilateral tumor with normal hearing in the opposite ear.

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