Acoustic neuroma: Viewpoint—surgery

Abstract

Acoustic neuromas are the most common tumors to arise in the cerebello-pontine angle. Treatment options for these typically benign tumors include observation, radiosurgery, microsurgical excision, or a combination of these modalities. Ideally, complementary employment of each of these strategies can be selected to optimize individualized patient outcomes. Although radiosurgical techniques have improved over the past several decades, surgical excision continues to play a major, and sometimes preferable, role in the management of acoustic neuromas in many patients. In particular, microsurgical excision is typically recommended in our practice for patients with larger tumors (over 3 cm in diameter), patients with tumor progression following radiosurgery, younger patients, and patients who prefer to undergo tumor excision. Safety and efficacy rates associated with surgical resection are excellent in experienced centers, especially when more conservative strategies for facial nerve and brainstem preservation are employed.​