Conservative management of acoustic neuroma: an outcome study.
OBJECTIVE
This study analyzed selection criteria, clinical outcome, and tumor growth rates in patients with acoustic neuromas in whom the initial management strategy was observation.


METHODS
A retrospective review of patients with conservatively managed unilateral acoustic neuromas was conducted. Minimum follow-up was 6 months. Patients with neurofibromatosis Type II were excluded. Differences in tumor growth rates were analyzed by use of the Wilcoxon rank sum test.


RESULTS
Sixty-eight patients (31 men and 37 women) with a mean age of 67.1 years were followed for an average of 3.4 years after diagnosis. The reasons for a trial of observation included advanced age (55%), patient preference (21%), minimal symptoms (9%), poor general medical condition (7%), asymptomatic tumor (4%), and tumor in the only hearing ear (4%). Fifty-eight patients (85%) were successfully managed with observation alone. Ten patients (15%) ultimately required treatment (nine received microsurgical treatment and one patient underwent radiosurgical intervention) at a mean time interval of 4.0 years after diagnosis. Forty-eight tumors (71%) showed no growth and 20 (29%) enlarged during the study period. The mean tumor growth rate at the 1-year follow-up was significantly higher in the group requiring treatment (3.0 mm) than in the group not requiring treatment (0.36 mm) (P < 0.0001). Thus, the tumor growth rate at the 1-year follow-up was a strong predictor of the eventual need for treatment.


CONCLUSIONS
Observation is a reasonable management strategy in carefully selected patients with acoustic neuromas. Diligent follow-up with serial magnetic resonance imaging is recommended, because some tumors will enlarge to the point at which active treatment is required.
Deen
H G
HG
Department of Neurosurgery, Mayo Clinic Scottsdale, Arizona, USA.
Ebersold
M J
MJ
Harner
S G
SG
Beatty
C W
CW
Marion
M S
MS
Wharen
R E
RE
Green
J D
JD
Quast
L
L
D000368:Aged; D000369:Aged, 80 and over; D002455:Cell Division / Q000502:physiology; D002530:Cerebellopontine Angle / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D016634:Radiosurgery; D012189:Retrospective Studies; D016896:Treatment Outcome