Commentary

Dr. Buchheit was well known for his expertise in dealing with acoustic tumors during his active career. This review thoroughly defines the outcomes expected of surgery for acoustic neuromas by the best surgeons currently involved. Cure of the tumor is the rule. The mortality rate is extremely low, but not zero. Cranial nerves are usually preserved, and satisfactory facial function can be obtained in almost all patients with smaller tumors. Hearing preservation data are still inadequate to make predictions for individual patients. This study adds to the significant number of patients reported from several institutions around the world with similar outcomes for surgery. There is now a solid database against which surgeons can assess their individual results and against which the outcomes for observation and radiation can be compared.

These reports do not settle the controversy between those who favor radiation for the treatment of acoustic tumors and those who favor surgery. That issue will only be resolved through prospective comparisons of the different forms of treatment or the accumulation of large data sets studied over the last 10 years with outcomes verified by independent observations. Although we cannot use these data to compare outcomes with focused radiation, these results and the other published series certainly allow patients to understand the risks and potential outcomes of surgery based on tumor size and preoperative symptoms. This study is a valuable addition to the literature and will be useful information for all surgeons who treat patients with acoustic tumors.