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.

STUDY

DESIGN

Retrospective case review.

SETTING

Tertiary referral center.

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

INTERVENTIONS: 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.

MAIN OUTCOME MEASURE: 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.