Fortnightly Review: Management of acoustic neuroma

Use of intraoperative ultrasonography to monitor surgery for large acoustic neuromas: a pilot study

“…The scope of surgery must be determined individually according to the location and size of the tumor, surrounding tissues, and clinical symptoms, thus improving the clinical outcomes. Complete removal was possible for some patients, and a fragment of the tumor had to be left in other cases [2,3]. IOUS was beneficial to those patients who were candidates for total resection.…”

“…IOUS can also assist in identifying the targeted volume and avoiding/ decreasing harm to tissues in need of protection, when performing partial tumor resection. For a large tumor, partial removal was frequently the preferred surgical management, which can preserve the nerve functions [2]. IOUS may be combined with preoperative CT/MRI scans to determine the optimum removal fraction of a tumor.…”

“…The removal of an acoustic neuroma is difficult as it is located in the CPA, a surgically awkward site. A large tumor usually deforms the anatomic structure, leading to the compression and extrusion of the brain stem, cerebellum hemisphere, and nerves [2]. Thus, CT/MRI scans are the gold standard to follow neurosurgical procedures [7,8].…”

“…An acoustic neuroma is actually a vestibular schwannoma, and surgical treatment is the standard management [2,3]. The removal of an acoustic neuroma is difficult as it is located in the CPA, a surgically awkward site.…”

“…Thus, surgery for an acoustic neuroma is one of the most difficult surgical procedures, with a high incidence of adverse events. Resection of a large tumor (with a maximum dimension of [3 cm) frequently leads to injuries to the brain stem, nerve, and vessels [2,3]. Techniques that are an adjunct to surgical procedures are therefore urgently needed.…”