[Neurosurgical treatment of acoustic neuromas without indication for radiosurgery].
The aim of this paper is to review the specific problems of the microsurgical management of the acoustic neuromas not suitable for radiosurgical treatment , that is measuring more than 8 cc in volume or 2.5 cm in maximum diameter in the cerebelopontine angle. A total of 18 lesions have been included with a mean volume of 27.4 cc, representing a lesion measuring 3.8 cm in its three main diameters. The mean follow-up has been 48.7 months. There has been no mortality. All lesions were completely excised without recurrences. The anatomic conservation of the facial nerve was achieved in the 66.7% of the cases but the functional recovery (House-Brackmann grades I-II) was reached only in the 27.8%, without any grade I case. As permanent deficit all patients had postoperative cophosis, two had trigeminal hyposthesia with corneal anesthesia and one had a cerebellar deficit. The main conclussion is that the microsurgical radical resection of large acoustic neuromas not suitable for radiosurgical treatment is followed by a high postoperative morbidity mainly related with the facial nerve lesion. Therefore, it seems rationale to design specific strategies directed to reduce and alleviate these permanent deficits.
González-Darder
J M
JM
Servicio de Neurocirugía, Hospital General de Castellón, Castellón de la Plana, Spain.
Pesudo-Martínez
J V
JV
Feliu-Tatay
R
R
Borrás-Moreno
J M
JM
D000328:Adult; D004428:Ear Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008866:Microsurgery / Q000295:instrumentation; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000473:pathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000295:instrumentation*; D016634:Radiosurgery; D012189:Retrospective Studies