The objective of acoustic neuroma surgery is the total removal of the neoplasm with minimal morbidity and mortality. Objective recording of cranial nerve function, CSF leak rates, meningitis incidence and quality-of-life assessments can assess morbidity. Extent of tumor removal can be determined intraoperatively, and recurrence can be monitored with MRI scans.
In the modern era, total tumor removal should be achieved. This was the case in 99.6% of patients with unilateral tumors in Cambridge. Recurrence of acoustic neuromas is exceptional, and has only been seen in two patients in our center between 1982 and 1998. In one of these cases (a patient with NF-2), the tumor was histologically malignant. We perform MRI scans 2 and 5 years post-operatively to ensure recurrence has not occurred.
The mortality of surgery for acoustic neuromas has reduced dramatically over the course of this century. Whilst Cushing's overall operative mortality was 11.4% , mortality figures of around 20% were reported in other historical series. However, microsurgical advances have reduced death rates, initially to 5%, then to around 2-3%. In the total Cambridge series of 660 acoustic neuroma operations, we have encountered eight deaths (1.2%). The causes of death include hematomas in the CPA or cerebellum, brainstem infarction and post-operative meningitis, in addition to concomitant medical complications.
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