Team Surgery for Acoustic Neurinomas and the Preservation of Hearing

Abstract

In a series of 26 patients with acoustic neurinomas, Feb. 1978 to June 1979, a joint neuro-otosurgical approach gave results optimistic for the future as regards hearing preservation and facial nerve function. in five ears, some hearing was preserved: these were all small tumours, extending at most 12 mm into the cerebellopontine cistern. Facial nerve function was preserved in 18 out of 24 survivors; the remaining 6 all had very large tumours. One death resulted from a recurrent postoperative haematoma in a 65-year-old patient with a very large tumour, and another from a heart infarction, in a 52-year-old patient with a small tumour. the size of the tumour is the crucial factor for preservation of hearing, thus early diagnosis is vital, and this is one of the chief advantages of departmental co-operation. Once suspicion of an acoustic neurinoma has been established, cisternography with metrizamide is essential for anatomical diagnosis of these small tumours; computer tomography is not yet accurate enough. Other advantages of a combined neuro-otosurgical approach are the wider exposure through a suboccipital approach than through the labyrinth, sharp postoperative surveillance in the neurosurgical intensive care unit and computer tomography for diagnosis of postoperative haematomas in the posterior fossa.