title: Management of acoustic neuromas in the elderly: retrospective study.
abstract: The wide availability of gadolinium-enhanced magnetic resonance imaging (MRI-Gd) has led to the discovery of an increasing number of small and less symptomatic acoustic neuromas in elderly patients. We conducted a retrospective study in order to obtain data on outcomes and complications associated with different management strategies that would be useful in establishing a management guideline. We identified 44 patients aged 65 to 77 years with acoustic neuromas who had been managed with either surgery or simple observation with MRI-Gd imaging. Of the entire group, 36 patients had tumors larger than 1 cm, and they underwent surgery (most via the translabyrinthine approach). Complete removal of the tumor was achieved in 34 of these patients (94.4%). At the 1-year follow-up, grade VI facial nerve paralysis was evident in only two of 35 evaluable patients (5.7%). Postsurgical complications occurred in five patients (13.9%), including one death. The remaining eight patients had tumors 1 cm or smaller, and they were managed with periodic MRI-Gd scanning. At the 5-year follow-up, no tumor growth was seen in six of these patients. The other two patients exhibited a tumor growth rate of less than 2 mm per year. No patient in the observation group required surgical intervention.
authors.affiliation: Department of ENT, Otology, Neurotology, and Skull Base Surgery, University of Parma, Italy. piazzafabio@hotmail.com
authors.forename: Fabio
authors.initials: F
authors.lastname: Piazza
authors.forename: Antonio
authors.initials: A
authors.lastname: Frisina
authors.forename: Angelo
authors.initials: A
authors.lastname: Gandolfi
authors.forename: Nicola
authors.initials: N
authors.lastname: Quaranta
authors.forename: Carlo
authors.initials: C
authors.lastname: Zini
mesh_terms: D000367:Age Factors; D000368:Aged; D001707:Biopsy, Needle; D005158:Facial Paralysis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D019786:Gadolinium DTPA; D006319:Hearing Loss, Sensorineural / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008991:Monitoring, Physiologic; D009464:Neuroma, Acoustic / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis; D011379:Prognosis; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D019786:Gadolinium DTPA