Acoustic Neuroma Treatment and Symptomatology: 25-Year Trends Based on Analysis of Patient Surveys from the Acoustic Neuroma Association

Objectives: To use the 1998 (1983–1998 inclusive) and 2008 Acoustic Neuroma Association (ANA) patient surveys to report trends and evolution in acoustic neuroma (AN) presentation, treatment, and treatment-related outcomes on a national level.

Materials and Methods: This cohort study analyzed the reported experiences of 1,934 members of the 2008 ANA survey. The results of the ANA survey were reviewed to determine respondents' pre- and postoperative symptoms and treatment. The responses were analyzed to detect trends of presenting symptoms, tumor size, treatment modality, and treatment outcomes. Results of the 2008 survey were compared with the 1983–1998 survey to establish 25-year trends in patient presentation and care. SPSS software was used to conduct statistical analysis.

Results: Patients with AN most commonly presented with hearing loss (88%), tinnitus (73%), and balance disturbance (59%). Similarly, patients of the 1998 survey reported hearing loss (88%), tinnitus (64%), and balance disturbance (64%) as presenting symptoms. In the last decade, tumor size at diagnosis decreased significantly (1998: 23% < 1.5 cm; 2008: 38% < 1.5 cm). From 1998 to 2008, the use of microsurgery (85%), radiosurgery/radiotherapy (5%), and observation (4%) showed a decrease in microsurgery (60%) and an increase in both radiosurgery/radiotherapy (20%) and observation methods (20%). The decrease was noted in two major subcategories of AN microsurgery: Translabyrinthine approach (1998–51% to 2008–33%) and retrosigmoid/ suboccipital approach (1998–28% to 2008–17%).

Discussion: Although acoustic tumor size at diagnosis has decreased in the past 10 years, patient symptomatology has remained largely unchanged. This national level, patient-driven review also confirms that management of acoustic tumors has seen significant decline in microsurgical treatment while radiation therapy/radiosurgery and observation have gained popularity. Persisting patient morbidities may merit a reevaluation of the shift in treatment strategy.

Conclusion: This review provides a glimpse into the changing face of acoustic tumor management from a patient's perspective over a 25-year period.