Surgical treatment of acoustic neuromas (vestibular schwannomas)

Abstract

Clinical guidelines are topical systematically developed provisions designed to help the doctor make a decision about a treatment approach in certain clinical situations; they provide information on conducting diagnostic and screening tests, the amount of medical and surgical care, and other aspects of clinical practice. Vestibular schwannomas account for 8% of all intracranial lesions, up to 30% of posterior cranial fossa tumors, and 85% of cerebellopontine angle tumors. The incidence rate of acoustic neuromas is approximately 1 case per 100000 population per year. The paper addresses the issues of classification, diagnosis, and treatment of acoustic neuromas. The guidelines discuss in detail the key aspects of formulation of clinical diagnosis, classification features, definition of the indications for surgical or radiation treatment, and principles of expectant treatment in vestibular schwannomas. The article pays particular attention to surgical treatment of acoustic neuromas and describes the criteria for choosing a surgical approach, use of modern surgical equipment, and stages of tumor resection. On the basis of the accepted clinical classification, we propose the algorithms of action depending on the disease stage, pathological process dynamics, patient's age, and clinical manifestations. The key points of the clinical guidelines rely on evidence-based criteria. The work is intended for neurosurgery practitioners.