Dr. House and his colleagues report a 70% hearing preservation rate in patients undergoing surgical removal of tumors less than 1.5 cm through the middle fossa.
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May 2008Infection associated with surgical removal of acoustic neuroma occurs in two of every 600 patients, he added.
In contrast, stereotactic radiation does not have an infection risk, and patients can receive the treatment on an outpatient basis and return to work within a day or two, said Dr. Young.
In addition to hearing loss, recurrence, and radiation-induced malignancies, however, fairly rare short- and long-term complications of stereotactic radiation include change in balance, chronic vertigo, cerebellar or cerebral edema, facial nerve weakness, hydrocephalus, trigeminal neuralgia, and facial nerve weakness, said Dr. Coelho.
Patients should also understand that stereotactic radiation will not remove the tumor, said Dr. House. Rather, it is designed to prevent the tumor from growing.
Some patients psychologically don’t do well having a tumor in their head, and for them, surgery may be the best option, said Dr. Bigelow.
Patients also need to be aware that observation is another option for addressing acoustic neuromas, said Dr. Coelho. Data show that in the long run most patients with acoustic neuromas who opt for observation will have worse outcomes than treated matched controls, he said. However, on an individual basis, this may be the most appropriate approach, especially for small, intracanalicular tumors.
Dr. Young usually observes patients if the tumors are small and hearing is normal or near normal, and an MRI has shown that the tumor is not growing.
The Bottom Line
Overall, physicians should keep in mind that stereotactic radiosurgery continues to evolve, said Dr. Coelho. Like any modality, it has advantages and disadvantages that must be considered and discussed with the patient, he said. It remains the neurotologist’s responsibility to lead that discussion.
©2008 The Triological Society
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