Conservative management of acoustic neuroma: an outcome study

Neurosurgery. 1996 Aug;39(2):260-4; discussion 264-6. doi: 10.1097/00006123-199608000-00005.


Objective: This study analyzed selection criteria, clinical outcome, and tumor growth rates in patients with acoustic neuromas in whom the initial management strategy was observation.

Methods: A retrospective review of patients with conservatively managed unilateral acoustic neuromas was conducted. Minimum follow-up was 6 months. Patients with neurofibromatosis Type II were excluded. Differences in tumor growth rates were analyzed by use of the Wilcoxon rank sum test.

Results: Sixty-eight patients (31 men and 37 women) with a mean age of 67.1 years were followed for an average of 3.4 years after diagnosis. The reasons for a trial of observation included advanced age (55%), patient preference (21%), minimal symptoms (9%), poor general medical condition (7%), asymptomatic tumor (4%), and tumor in the only hearing ear (4%). Fifty-eight patients (85%) were successfully managed with observation alone. Ten patients (15%) ultimately required treatment (nine received microsurgical treatment and one patient underwent radiosurgical intervention) at a mean time interval of 4.0 years after diagnosis. Forty-eight tumors (71%) showed no growth and 20 (29%) enlarged during the study period. The mean tumor growth rate at the 1-year follow-up was significantly higher in the group requiring treatment (3.0 mm) than in the group not requiring treatment (0.36 mm) (P < 0.0001). Thus, the tumor growth rate at the 1-year follow-up was a strong predictor of the eventual need for treatment.

Conclusion: Observation is a reasonable management strategy in carefully selected patients with acoustic neuromas. Diligent follow-up with serial magnetic resonance imaging is recommended, because some tumors will enlarge to the point at which active treatment is required.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cell Division / physiology
  • Cerebellopontine Angle / pathology
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Microsurgery
  • Middle Aged
  • Neuroma, Acoustic / diagnosis
  • Neuroma, Acoustic / pathology
  • Neuroma, Acoustic / therapy*
  • Radiosurgery
  • Retrospective Studies
  • Treatment Outcome