Management of acoustic neuroma in the elderly population.
OBJECTIVE
Ongoing controversy regarding the optimal treatment of acoustic neuromas in the elderly population has prompted us to examine the our experience in order to arrive at a treatment algorithm.


METHODS
Retrospective case review.


METHODS
Tertiary referral center.


METHODS
The records of 48 elderly patients ranging from age 70 to 90 years with acoustic tumors were reviewed.


METHODS
In 34 cases, tumor size was followed through serial imaging for a mean 28.5 months (range 5-108 months). Eight of these patients subsequently required surgery for significant tumor growth. An additional 12 patients were managed surgically from the time of diagnosis.


METHODS
The natural history of acoustic neuromas in the elderly population.


RESULTS
The mean tumor growth rate for the watched group was 0.29 cm/y. Fifteen patients demonstrated no growth whereas accelerated growth was noted in eight cases. Ten patients with tumors confined to the internal auditory canal demonstrated an average growth rate of only 0.06 cm/y over a mean interval of 38 months. For the surgically treated group, the mean tumor size at the time of resection was 2.8 cm. Resection was described as complete in 17 cases and near-total in three cases. Perioperative complication rates and facial nerve results were comparable to our figures for all age groups. There was one perioperative death.


CONCLUSIONS
Elderly patients with small acoustic neuromas should be offered a trial of observation. When significant tumor growth, size, or neurologic deterioration are demonstrated, early surgical intervention is required to avoid complications associated with the removal of larger tumors.
Glasscock
M E
ME
Otology Group, Nashville, Tennessee, USA.
Pappas
D G
DG
Manolidis
S
S
Von Doersten
P G
PG
Jackson
C G
CG
Storper
I S
IS
D000005:Abdomen / Q000473:pathology; D000293:Adolescent; D000368:Aged; D001927:Brain Diseases / Q000209:etiology / Q000601:surgery; D002528:Cerebellar Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D002530:Cerebellopontine Angle / Q000473:pathology* / Q000601:surgery*; D004428:Ear Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D007758:Ear, Inner / Q000473:pathology* / Q000601:surgery*; D005154:Facial Nerve / Q000601:surgery; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis / Q000209:etiology; D006406:Hematoma / Q000209:etiology / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D009464:Neuroma, Acoustic / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016055:Urinary Retention / Q000209:etiology