Management of acoustic neuromas in patients 65 years or older.
OBJECTIVE
To analyze an optimal management protocol for patients 65 years or older at the time of acoustic neuroma diagnosis.


METHODS
Retrospective case review.


METHODS
Tertiary care hospital.


METHODS
Two hundred sixteen patients with acoustic neuroma 65 years or older at time of diagnosis.


METHODS
Patients with smaller tumors (<2.5 cm) were followed with serial magnetic resonance imaging. If significant growth occurred, they were treated with surgery. Surgery was performed at initial diagnosis on patients with larger tumors or in selected patients for hearing preservation. Stereotactic radiotherapy was performed for poor surgical candidates and for patient choice.


METHODS
Measurement of acoustic neuroma growth and tabulation of complications.


RESULTS
One hundred fourteen patients were initially managed by observation, 80 with surgery, and 3 with radiation therapy, with an average follow-up of 35.4 months. For patients in the observation group, average tumor growth was 1.2 mm/yr. Thirty-two patients required crossover to surgery or radiotherapy due to tumor growth (average growth, 4.1 versus 0.3 mm/yr for those remaining in the observation group). One of the patients in the observation group had a complication (0.9%).


CONCLUSIONS
Management of acoustic neuromas in elderly patients can be based on size and "biological age" criteria. Surgical treatment can safely be reserved for the few patients who have significant tumor growth.
Department of Otolaryngology, New York University School of Medicine, New York, New York, and Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA.
Pamela C
PC
Roehm
Bruce J
BJ
Gantz
D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006311:Hearing Disorders / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D008297:Male; D009464:Neuroma, Acoustic / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D013506:Otologic Surgical Procedures / Q000379:methods*; D011878:Radiotherapy; D012189:Retrospective Studies; D013238:Stereotaxic Techniques