Acoustic neuroma: outcome of surgical resection and study on the anatomy of facial and cochlear nerves.

The treatment of acoustic neuroma (vestibular schwannoma) has evolved greatly. In this report, we studied the history of acoustic tumour surgery, and documented the value of technical advances in benefiting patients. We also present our outcome of surgery for this benign tumour in support of its use as the treatment of choice. In 611 patients undergoing initial surgery at Johns Hopkins from 1973-1994, complete resection was obtained in all but one case (intentional), and permanent morbidity and mortality rate was 0.3%. Including temporary morbidity, the rate was 3.8%. Tumour recurrence was seen in only 0.8% of cases. The facial nerve was preserved in 97.6% and function at one-year was House-Brackmann grade 1 or 2 in 89.7%. Lastly, we present results of an anatomical study localizing the nerves and vessels, and the frequency of involvement by tumour, associated with acoustic neuromas in 1006 surgical cases. We continue to offer surgery as the best treatment option for the majority of our patients, and prefer the suboccipital route because of its unrestricted access to all posterior fossa structures, and ability to preserve hearing.