The small acoustic tumour; a chance to preserve hearing

Abstract

The authors report their experience in the surgical management of small (less than 1.5 cm diameter) acoustic neuromas. Twenty-nine patients were treated. They had suffered symptoms of unilateral eighth nerve dysfunction on average for 37 months. High resolution CT with iv contrast was the primary investigation. In equivocal cases, air meatography was performed. All operations were performed by the senior author (LS). All tumours were totally removed, there were no deaths and all patients had an excellent result. There were 6 complications (CSF leak 3; meningitis 2; deep venous thrombosis 1). The facial nerve was preserved in 26 cases (and functioned adequately in all) and the cochlear nerve in 62%. In 4 cases with hearing pre-operatively, the decibel loss was the same or less post operatively. In 8 cases speech discrimination remained above 35%.

Hearing preservation in vestibular schwannoma surgery: what factors influence outcome?

“…Hearing preservation as a specific goal has not only generated an enormous exchange of ideas in the literature but has also created a labyrinth of data collected utilizing different classification and measurement schemes. 1,2,[5][6][7]9,10,[15][16][17][18]20,21,24,25,[27][28][29][30][31]33,34,37,[39][40][41][42]44,46,48,[51][52][53][55][56][57][58][59][60][62][63][64][65][66] As Glasscock and colleagues 20 recently pointed out, there is no adequate way to analyze the literature regarding hearing preservation because there is no standardization of the relevant pre-and postoperative parameters. In addition, many reports fail to document pre-and postoperative audiograms.…”

Issues in the Optimal Selection of a Cranial Nerve Monitoring System

“…Other investigators also report doubt that intraoperative BAER monitoring substantially aids in hearing preservation. 29 Despite the questions about BAER and hearing preservation, BAER data may be used as a prognostic indicator for postoperative hearing. In 1989, Watanabe and coinves-tigators30 reported that loss of wave V is usually associated with loss of useful hearing and that preservation of waves I and V usually indicates the possibility of retained useful hearing.…”

Hearing preservation in acoustic neuroma surgery

“…Gadolinium enhanced coronal MRI scan showing a small brightly enhanced 6 rnm intracanalicular acoustic neuroma ~ arrowed (case 12). Note that the fundus is free of tumour.…”