Early microsurgery of small acoustic neuromas – therapy of choice

Introduction 

Acoustic neuromas are rare benign tumors of the lateral skullbase. Typical symptoms in the early stages are hearing loss, tinnitus and vertigo. Improved diagnostics often leads to early diagnosis in sometimes asymptomatic patients. Therapy strategies are microsurgery, radiation and wait&scan. There is a lot of controversy about whether small tumors need treatment at all. Observation of large collectives show that even small tumors grow significantly over the years and that wait&scan over 3-4 years leads to hearing loss in 50% of cases. Delayed resection of larger tumors is associated with increased morbidity and poorer functional outcomes.

Material and Methods 

The data of 340 patients with microsurgery for purely intrameatal (T1) and intra-/extrameatal tumors without contact to the brainstem (T2) out of the last 15 years was analyzed. In particular, functional results such as hearing and facial nerve function were evaluated. Furthermore, a focus was placed on the pre- and post-operative quality of life as well as on the changes caused by the operation.

Results 

Our data shows very good functional results, with a facial nerve preservation rate (HB I+II) of >90% and a hearing preservation rate (AAO-HNS A+B) of 60-70%. The quality of life could also be kept at a stable level in these patients.

Conclusion 

Our experience over a very long period of time shows that early resection via the middle fossa approach plays a relevant role in the treatment of small acoustic neuromas. It is the therapy of choice in order to achieve safe tumor resection at an early stage while maintaining function and QOL.

Publikationsverlauf

Artikel online veröffentlicht:
24. Mai 2022