RSS-Feed abonnieren
DOI: 10.1055/s-2006-934112
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.
Conservative Management of Acoustic Neuroma
Publikationsverlauf
Publikationsdatum:
01. April 2006 (online)
ABSTRACT
Aim of study: To identify those patients with vestibular schwannoma (acoustic neuroma) in whom treatment becomes necessary. Method: Retrospective chart review. Result: A total of 205 patients with small tumors were followed for a mean of 40.8 months. The longest follow-up was 180 months. One hundred and ninety-seven patients had a follow-up of more than 12 months. Eight patients with a follow-up of less than 12 months were excluded from the study. In 136 patients (66.3%) the tumor did not grow. Forty-seven patients (23.9%) showed some evidence of slow growth. Eight of 197 patients (4%) had rapid growth and 6 patients (3%) had radiological evidence of tumor regression. Fifteen patients came to surgery. Five of these showed rapid growth, four developed ataxia in whom tumor growth was slow, three had ataxia without tumor growth, two patients developed brainstem compression, and one patient elected to proceed to surgery, although there were no tumor growth or symptoms. Conclusion: Few patients with small tumors will come to surgery in the short term. Perhaps the majority of patients with such small tumors will not need surgery. Long-term follow-up studies of 20 years or more are required to be come more confident about the natural history of these tumors. This study continues.
KEYWORDS
Acoustic neuroma - cerebellopontine angle - magnetic resonance imaging - nonsurgical management
REFERENCES
- 1 Lanser M J, Sussman S A, Frazer K. Epidemiology, pathogensis, and genetics of acoustic tumors. Otolaryngol Clin North Am. 1992; 25 499-520
- 2 Nedzelski J M, Schessel D A, Pfleiderer A, Kassel E E, Rowed D W. Conservative management of acoustic neuromas. Otolaryngol Clin North Am. 1992; 25 691-705
- 3 Silverstein H, McDaniel A, Norrell H, Wazen J. Conservative management of acoustic neuroma in the elderly patient. Laryngoscope. 1985; 95 766-770
- 4 Strasnick B, Glasscock 3rd M E, Haynes D, McMenomey S D, Minor L B. The natural history of untreated acoustic neuromas. Laryngoscope. 1994; 104 1115-1119
- 5 Rosenberg S I, Silverstein H, Gordon M A, Flanzer J M, Willcox T O, Silverstein J. A comparison of growth rates of acoustic neuromas: non-surgical patients vs. subtotal resection. Otolaryngol Head Neck Surg. 1993; 109 482-487
- 6 Wazen J, Silverstein H, Norrell H, Bessc B. Preoperative and postoperative growth rates in acoustic neuromas documented with CT scanning. Otolaryngol Head Neck Surg. 1985; 93 151-155
- 7 Silverstein H, Rosenberg S I, Flanzer J M, Wahamaker H H, Seidmen M D. An algorithm for the management of acoustic neuromas regarding age, hearing, tumor size, and symptoms. Otolaryngol Head Neck Surg. 1993; 180 1-10
- 8 Nedzelski J M, Canter R J, Kassel E E, Rowed D W, Tator C H. Is no treatment good treatment in the management of acoustic neuromas in the elderly?. Laryngoscope. 1986; 96 825-829
- 9 Nedzelski J M, Schessel D A, Pfleiderer A, Kassel E E, Rowed D W. Conservative management of acoustic neuromas. Otolaryngol Clin North Am. 1992; 25 691-705
- 10 Jørgensen B G, Pedersen C B. Acoustic neuroma. Follow-up of 78 patients. Clin Otolaryngol Allied Sci. 1994; 19 478-484
- 11 Martin C, Martin H, Portafaix M, Saby J L. De la particulière lenteur dévolution de certains neurinomes de l'acoustique [peculiarly slow development of several acoustic neuromas. Management.] Ann Otolaryngol (Chir Cervicofac). 1985; 102 19-29
- 12 Wazen J, Silverstein H, Norrell H, Besse B. Preoperative and postoperative growth rates in acoustic neuromas documented with CT scanning. Otolaryngol Head Neck Surg. 1985; 93 151-155
- 13 Clark W C, Moretz Jr W H, Acker J D, Gardner L G, Eggers F, Robertson J H. Nonsurgical management of small and intracanalicular acoustic tumors. Neurosurgery. 1985; 16 801-803
- 14 Laasonen E M, Troupp H. Volume growth rate of acoustic neurinomas. Neuroradiology. 1986; 28 203-207
- 15 Gardner G, Moretz Jr W H, Robertson J H, Clark C, Shea Jr J J. Nonsurgical management of small and intracanalicular acoustic tumors. Otolaryngol Head Neck Surg. 1986; 94 328-333
- 16 Kassel E E, Nedzelski J M, Canter R J, Rowed D W, Cooper P W. Radiologic assessment of acoustic neuroma in the elderly: Is no treatment good treatment?. Acta Radiol Suppl. 1986; 369 182-185
- 17 Thomsen J, Tos M. Acoustic neuromas. Diagnostic delay, growth rate and possible non-surgical treatment. Acta Otolaryngol Suppl. 1988; 452 26-33
- 18 Valvassori G E, Guzman M. Growth rate of acoustic neuromas. Am J Otol. 1989; 10 174-176
- 19 Wiet R J, Young N M, Monsell E M, O'Connor C A, Kazan R. Age considerations in acoustic neuroma surgery: the horns of a dilemma. Am J Otol. 1989; 10 177-180
- 20 Thomsen J, Tos M. Acoustic neuroma: clinical aspects, audiovestibular assessment, diagnostic delay, and growth rate. Am J Otol. 1990; 11 12-19
- 21 Bederson J B, von Ammon K, Wichmann W W, Yasargil M G. Conservative treatment of patients with acoustic tumors. Neurosurgery. 1991; 28 646-650
- 22 Anand V T, Kerr A G, Byrnes D P, Smyth G D. Non-surgical management of acoustic neuromas. Clin Otolaryngol Allied Sci. 1992; 17 406-410
- 23 Strasnick B, Glasscock 3rd M E, Haynes D, McMenomey S O, Minor L B. The natural history of untreated acoustic neuromas. Laryngoscope. 1994; 104 1115-1119
- 24 Wiet R J, Zappia J J, Hecht C S, O'Connor C A. Conservative management of patients with small acoustic tumors. Laryngoscope. 1995; 105 795-800
- 25 Charabi S, Thomsen J, Mantoni M et al.. Acoustic neuroma (vestibular schwannoma): growth and surgical and nonsurgical consequences of the wait-and-see policy. Otolaryngol Head Neck Surg. 1995; 113 5-14
- 26 Deen H G, Ebersold M J, Harner S G et al.. Conservative management of acoustic neuroma: an outcome study. Neurosurgery. 1996; 39 260-264 , discussion 264-266
- 27 Levo H, Pyykkö I, Blomstedt G. Non-surgical treatment of vestibular schwannoma patients. Acta Otolaryngol Suppl. 1997; 529 56-58
- 28 Yamamoto M, Hagiwara S, Ide M et al.. Conservative management of acoustic neurinomas: prospective study of long-term changes in tumor volume and auditory function. Minim Invasive Neurosurg. 1998; 41 86-92
- 29 Niemczyk K, Vaneecloo F M, Lemaitre L et al.. The growth of acoustic neuromas in volumetric radiologic assessment. Am J, Otol. 1999; 20 244-248
- 30 Mirz F, Jørgensen B, Fiirgaard B, Lundorf E, Pedersen C B. Investigations into the natural history of vestibular schwannomas. Clin Otolaryngol Allied Sci. 1999; 24 13-18
- 31 Smouha E E, Yoo M, Mohr K, Davis R P. Conservative management of acoustic neuroma: a meta-analysis and proposed treatment algorithm. Laryngoscope. 2005; 115 450-454
- 32 Long S A, Arriaga M, Nelson R A. Acoustic neuroma volume: MRI-based calculations and clinical implications. Laryngoscope. 1993; 103 1093-1096
- 33 Fiirgaard B, Pedersen C B, Lundorf E. The size of acoustic neuromas: CT and MRI. Neuroradiology. 1997; 39 599-601
- 34 Monsell E M, Cody D D, Spickler E, Windham U P. Segmentation of acoustic neuromas with magnetic resonance imaging and Eigen image filtering. Am J Otol. 1997; 18 602-607
- 35 Toner J G, Smyth G D. Comparison of methods of evaluating benefit of middle ear surgery. J Laryngol Otol. 1993; 107 4-5
- 36 Browning G G, Gatehouse S, Swan I R. The Glasgow Benefit Plot: a new method for reporting benefits from middle ear surgery. Laryngoscope. 1991; 101 180-185
Paul A FaganM.D.
352 Victoria S., Darlinghurst NSW 2010, Australia
eMail: pfagan@pfagan.com.au