Tactics of Surgical Treatment of Large and Giant Acoustic Neuroma

Introduction: Surgical treatment of large and giant acoustic neuromas (>3 cm) remains a challenge, especially when their radical removal, as involvement in neurovascular structures, may lead to unsatisfactory results and a lower quality of life for patients. A judicious combination of surgical excision is followed by observation and ability to use modern methods of radiation therapy to reduce the risk of mortality, postoperative complications, and to maintain a decent quality of life without compromising the radical treatment.

Objective: Develop tactics of treatment of patients with large and giant acoustic neuroma.

Materials and Methods: We operated on 500 patients with large and giant acoustic neuroma lager than 3 cm. The main tactic was the maximal removal the tumor, followed by observation and/or radiotherapy treatment. All patients after surgery were followed without immediately directions to a radiologist, except those who held the volume of transactions “partial removal” or “open biopsy.” In case of continued growth in the groups with “near-total” or “subtotal” removal, patients underwent radiation therapy.

Results: At 1 year after surgery, outcome function of the facial nerve on the House-Brackmann scale I-III consist of ~90%; IX and X cranial nerves deficit consist of less than 1%; mortality less than 1%.

Conclusion: Combined tactic to this group of the patients allowed to reduce the incidence of postoperative complications: bulbar disorders, dysfunction of the trigeminal and facial nerves, and shorten the postoperative recovery period.