Selection of surgical approaches for small acoustic neurinomas

BACKGROUND The purpose of this study was to evaluate the results of surgery for small acoustic neurinomas at our institute via the middle cranial fossa and retrosigmoid approaches, and to determine the indications for each approach. METHODS Fifty-three patients with unilateral tumors less than 2 cm...

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Bibliographic Details
Published in:Surgical neurology 2000, Vol.53 (1), p.52-60
Main Authors: Kumon, Yoshiaki, Sakaki, Saburo, Kohno, Kanehisa, Ohta, Shinsuke, Nakagawa, Koh, Ohue, Shiroh, Murakami, Shingo, Yanagihara, Naoaki
Format: Article
Language:English
Subjects:
Acoustic neurinoma
Adult
Aged
Craniotomy - adverse effects
Craniotomy - methods
Craniotomy - standards
Facial Nerve - physiopathology
facial nerve function
Female
Hearing Loss - etiology
hearing preservation
Humans
Male
Middle Aged
middle cranial fossa approach
Neuroma, Acoustic - complications
Neuroma, Acoustic - pathology
Neuroma, Acoustic - surgery
Patient Selection
retrosigmoid approach
Treatment Outcome
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Summary:BACKGROUND The purpose of this study was to evaluate the results of surgery for small acoustic neurinomas at our institute via the middle cranial fossa and retrosigmoid approaches, and to determine the indications for each approach. METHODS Fifty-three patients with unilateral tumors less than 2 cm in diameter were studied. Surgery was performed via the middle cranial fossa approach in 36 tumors and via the retrosigmoid approach in 17 tumors. RESULTS The hearing preservation rate was 68% (36/53) in all patients, 93% (14/15) in patients with intracanalicular tumors, 79% (15/19) in patients with tumors less than 1 cm in diameter, and 43% (7/19) in patients with tumors between 1 and 2 cm in diameter. The facial nerve function was excellent or good in 80% (42/53), 74% (11/15), 84% (16/19), and 78% (15/19), respectively. Among the 19 patients with tumors between 1 and 2 cm in diameter, the frequencies of hearing preservation and of excellent or good facial nerve function (47% and 87%, respectively) in the 15 patients approached via the retrosigmoid approach were higher than those (0% and 50%, respectively) in the four patients approached via the middle cranial fossa approach. CONCLUSIONS We conclude that tumors smaller than 2 cm should be removed because preservation of hearing as well as facial nerve function may be possible in almost all of these patients. Tumors larger than 1 cm should be surgically treated through the retrosigmoid approach.
ISSN:0090-3019
1879-3339
DOI:10.1016/S0090-3019(99)00199-8