Acoustic Neuroma: An Investigation of Associations between Tumor Size and Diagnostic Delays, Facial Weakness, and Surgical Complications

Abstract

We conducted a retrospective case review to ascertain the clinical characteristics associated with acoustic neuromas and their treatment. Our study population was made up of 96 patients—41 men and 55 women, aged 17 to 84 years (mean: 54)—who had undergone treatment for acoustic neuromas and for whom necessary data were available. We compiled data on presenting symptoms, the interval from symptom onset to diagnosis, tumor size at diagnosis, facial weakness, the interval from diagnosis to surgery, the type of surgical approach, and surgical complications. Our primary goals were to determine if tumor size was correlated to (1) the interval from symptom onset to diagnosis, (2) the degree of preoperative facial weakness, and (3) surgical complications. We also sought to document various other clinical characteristics of these cases. The mean interval from the first symptom to diagnosis was 4.5 years; the time to diagnosis did not correlate with tumor size. Nor was tumor size correlated with the degree of preoperative facial weakness as determined by facial electroneurography. Surgical complications occurred in 15 of the 67 patients who underwent surgery (22.4%), and they did correlate with tumor size. The most common complications were postoperative facial weakness (13.4% of operated patients), cerebrospinal fluid leak (6.0%), and infection (3.0%). Since tumors typically grow about 2 mm per year and since larger tumors are associated with more severe symptoms and surgical complications, we expected that the time to diagnosis would correlate with tumor size, but we found no significant association.

Incidence of Prolonged Systemic Steroid Treatment after Surgery for Acoustic Neuroma and Its Implications

“…17 It is established that surgical complications, including facial weakness, CSF leak, and infection, following acoustic neuroma resection are associated with larger tumor size. 6,7 The present findings support this with a trend toward less postoperative steroids in small, nonintracanalicular tumors, though this trend was not statistically significant. Patients with tumors smaller than 1 cm had the lowest incidence of prolonged initial steroid tapers and additional courses.…”

“…Some studies have shown that complication rates following acoustic neuroma surgery vary by tumor size and surgical approach. [5][6][7] The most common complications overall include hearing loss, facial nerve dysfunction, cerebrospinal leak, and postoperative headache. 5 Despite the frequent use of steroids for these complications, there is a paucity of evidence in the literature to indicate that steroids improve outcomes.…”

Risk factors for postoperative meningitis after microsurgery for vestibular schwannoma

“…To prevent the complication of meningitis after operation for acoustic neuroma, the first step is to make an early diagnosis when the acoustic neuroma is still relatively small. Larger tumors are associated with more severe symptoms and surgical complications[27]. Improving surgeon proficiency and strengthening communication and logistics among surgical professionals can reduce the operation time.…”

Association between socioeconomic indicators and geographic distribution of vestibular schwannomas in West Scotland: a 15-year review

“…23 However, this issue may be more pronounced for immigrants where a lack of access to healthcare or health insurance coverage can further exacerbate diagnostic delays. 24 This can have downstream effects as well because individuals who do not have health insurance coverage are less likely to receive treatment for vestibular schwannomas when compared to their counterparts. 25 Further studies are needed to understand the patient recognition and diagnostic intervals in the immigrant population in the UK.…”