Contemporary Management of Acoustic Neuromas

Objectives/Hypothesis: This review of the literature on vestibular schwannomas focuses on the developments in the fields of surgery, radiosurgery, and observation during the past decade that have redefined the treatment algorithm. The authors hope to derive some recommendations that are evidence based and applicable to everyday clinical practice while advancing the dialogue regarding the optimal management of these lesions. Study Design: Contemporary review. Methods: English literature search for acoustic neuroma or vestibular schwannoma. Results: Radiosurgical treatment appears to maintain strong tumor control during an ever-increasing number of years of follow-up. Fractionated radiation therapy, with attention to limiting the cochlear radiation dose, seems to afford the best hearing-nerve functional outcomes. Microsurgical treatment remains the best cytoreductive therapy, and although it cannot achieve the facial and hearing nerve outcomes of radiosurgery, it is still the preferred treatment for large lesions causing mass effect and obstructive hydrocephalus. Bevacizumab holds substantial promise for the treatment of neurofibromatosis type 2-associated progressive lesions. Conclusions: Our review of the literature suggests that near-total or extensive subtotal resection of vestibular schwannomas may confer much improved functional outcomes without significant detriment to acceptable rates of tumor control. However, further follow-up is needed in patients treated with this relatively novel surgical paradigm.