Patients with acoustic neuroma present a variety of treatment options. Simplification of the protocol includes: serial imaging; radiosurgery; and hearing and non-hearing preservation surgical removal. In this lecture, we will discuss the various options and present case examples as a means to better understand the choices patients have. Ultimately, each case is individualized. Factors that must be considered include: age, size, location, hearing levels, and degree of vestibular symptoms, and realistic expectations of comparative outcomes. Comparisons of the choices are presented to each patient and a treatment plan is made with a strong focus on education of the patient. Ultimately, the informed patient is encouraged to make the final decision.
It is also extremely important that the single team can provide all surgical techniques as well as radiation options in order to eliminate bias in the presentation of the treatment options.
Many patients can benefit from hearing preservation techniques including middle cranial fossa removal as well as retrolabyrinthine surgery. Both these novel techniques have been developed to avoid significant contact with the brain tissue, thereby reducing the complications associated brain retraction which is the foundation of “Cranial Base Surgery” Retrolabyrinthine anatomy and resection is detailed below.
Middle cranial fossa surgery can be viewed below: