Management of acoustic neuromas in patients 65 years or older

Objective: To analyze an optimal management protocol for patients 65 years or older at the time of acoustic neuroma diagnosis. Study Design: Retrospective case review. Setting: Tertiary care hospital. Patients: Two hundred sixteen patients with acoustic neuroma 65 years or older at time of diagnosis. Intervention: Patients with smaller tumors (< 2.5 cm) were followed with serial magnetic resonance imaging. If significant growth occurred, they were treated with surgery. Surgery was performed at initial diagnosis on patients with larger tumors or in selected patients for hearing preservation. Stereotactic radiotherapy was performed for poor surgical candidates and for patient choice. Outcome Measures: Measurement of acoustic neuroma growth and tabulation of complications. Results: One hundred fourteen patients were initially managed by observation, 80 with surgery, and 3 with radiation therapy, with an average follow-up of 35.4 months. For patients in the observation group, average tumor growth was 1.2 mm/yr. Thirty-two patients required crossover to surgery or radiotherapy due to tumor growth (average growth, 4.1 versus 0.3 mm/yr for those remaining in the observation group). One of the patients in the observation group had a complication (0.9%). Conclusion: Management of acoustic neuromas in elderly patients can be based on size and biological age criteria. Surgical treatment can safely be reserved for the few patients who have significant tumor growth.