Conservative management of acoustic neuroma: a meta-analysis and proposed treatment algorithm

Laryngoscope. 2005 Mar;115(3):450-4. doi: 10.1097/00005537-200503000-00011.


Objectives/hypotheses: Conservative management is a viable treatment alternative for acoustic neuroma. Using previous studies to provide evidence-based support, we have attempted to more clearly define the role of conservative management.

Study design: Retrospective review of literature and patient charts.

Methods: Published studies on conservative management of acoustic neuroma were found using a key word search through PubMed in addition to the bibliographies of these selected studies. A spreadsheet was made to tabulate the selection criteria for conservative management, duration and frequency of follow-up, patient demographics, initial tumor size and rate of growth, change in hearing status, and the need for definitive treatment.

Results: A total of 21 studies comprising 1,345 patients were included in our meta-analysis. The average length of follow-up these studies was 3.2 years. The average initial tumor size was 11.8 mm (n = 900); 43% of 1,244 acoustic neuromas showed growth, whereas 57% showed either no growth or tumor regression. The average growth rate was 1.9 mm/year in 793 individuals. Hearing loss occurred in 51% of 347 individuals. In 15 studies, 20.0% of 1,001 individuals eventually failed conservative management.

Conclusions: Our meta-analysis supports the role of conservative management of acoustic neuromas in properly selected patients on the basis of a slow overall rate of growth and a substantial incidence of no growth. However, the lack of predictive factors, the relatively short duration of follow-up, and the variability of inclusion criteria underscore the need for continued collection of long-term data. An algorithm for acoustic neuroma management is proposed based on initial tumor size, patient age, and hearing status.

Publication types

  • Meta-Analysis

MeSH terms

  • Algorithms*
  • Follow-Up Studies
  • Hearing Loss / etiology
  • Humans
  • Middle Aged
  • Neuroma, Acoustic / therapy*
  • Retrospective Studies
  • Time Factors