Update on conservative management of acoustic neuroma

Objective: To update the authors' experience with conservative management of acoustic neuromas. Study Design: Retrospective chart review. Setting: Private practice and tertiary care referral setting. Intervention: Of 600 patients with acoustic neuroma, 102 were treated with the wait and scan treatment option. At least two magnetic resonance imaging scans were required of all patients. Main Outcome Measures: Change in tumor size over time was evaluated, as were clinical symptoms: hearing status, tinnitus, balance disturbance, aural fullness, vertigo, headache, and facial pain, numbness, or weakness. Results: Of 102 patients, the average follow-up time interval was 28.5 months. Forty-five (44%) of 102 patients demonstrated a change in tumor size: an average total growth of 2.17 mm per year. In the remaining 54 patients (53%), no growth was demonstrated during a mean follow-up of 28.5 months. Three patients demonstrated actual tumor shrinkage. Of the 102 patients receiving conservative treatment, 85 (84%) reported hearing loss, 67 (66%) tinnitus, 37 (36%) balance disturbance, 29 (28%) aural fullness, 28 (27%) vertigo, 7 (7%) headache, 4 (4%) facial numbness, 2 (2%) facial weakness, and 0 (0%) facial pain. Conclusion: Conservative management-wait and scan-for selected patients with acoustic neuroma is a reasonable choice of management instead of radiation or microsurgery. In some situations the individual morbidities associated with surgery or radiation make those treatments not in the patient's best interests. A third option is necessary in patients who cannot or do not wish to undergo those other treatments.