Treatment Strategies in Patients with Acoustic Neuromas

When considering the management of a patient with an acoustic neuroma, several factors preside. The size of the tumor is of paramount importance. In the Cambridge series of 473 patients presenting between 1983 and 1995, 47% of tumors were large (more than 2.5 cm), 32% medium (1.5-2.5 cm) and 21% small (less than 1.5 cm). Large tumors may cause the life-threatening complications of symptomatic hydro-cephalus, and direct mass effect. We advocate initial insertion of a ventriculoperitoneal shunt, or, in suitable cases, a third ventriculostomy, to alleviate hydrocephalus. If mass symptoms are evident, early surgery to remove the tumor should be considered. The initial presentation of these tumors in this way is now rare.

At presentation, most acoustic neuromas present with audiovestibular symptoms and do not constitute a threat to life at that time. A complete understanding of the natural history, surgical morbidity and success of radiosurgery is of importance in deciding the appropriate management of patients with these tumors.

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