Acoustic neuromas in the elderly.

OBJECTIVE

To determine if an "observation" protocol with serial scanning is a safe and effective management paradigm for acoustic neuromas in the elderly.

STUDY

DESIGN

A retrospective case review was performed.

SETTING

This study was performed in an academic, tertiary care center.

PATIENTS: Forty-one patients over the age of 65 years were identified with the primary diagnosis of unilateral acoustic neuroma, without prior treatment or observation.

INTERVENTION: The patients were followed with serial, gadolinium-enhanced magnetic resonance imaging (MRI) scans performed at 6 months and then yearly, if no significant growth occurred.

MAIN OUTCOME MEASURES: The patients were monitored for tumor growth, cranial nerve deficits, and hydrocephalus.

RESULTS

The patients were followed for an average of 3.5 years (range, 6 months to 9 years). The average tumor size at presentation was 1.14 cm, with a range of growth rates from 0 to 1.2 cm per year. Twenty-one patients demonstrated tumor growth at an average rate of 0.322 cm per year. Only five patients (12%) required further intervention. Three patients underwent translabyrinthine excision, and two patients were treated with radiation. No patients developed significant complications during the observation period.

CONCLUSIONS

Acoustic neuromas in the older population can be managed safely using serial MRI scanning. No correlation could be made between initial tumor size and subsequent growth rate.