Counseling patients on surgical options for treating acoustic neuroma.

The selection of surgical approach for the removal of AN is a complex one, depending on factors related to specific tumor anatomy, patient characteristics, and the familiarity and skill level of the skull base team.Overall, the literature supports that surgical outcomes are acceptable in regard to tumor removal, patient safety, and complication rates. The inconsistent reporting methods in the current literature make it difficult to assess logically the rates for hearing preservation, facial nerve outcome, and complications as controlled for tumor size and other preoperative patient characteristics. The best conclusions would be from prospective surgical trials controlling for patient factors, size of the tumor, and experience of the skull base team. In the absence of such studies, formal meta-analyses may help clarify specific differences among approaches.