The overall growth rate in these nonsurgical patients was 0.91 mm/year. During a mean follow-up of 4.8 years in 80 patients with no prior treatment, 42% exhibited no growth. The mean growth rate of 64% of the tumors was 1.6 mm/ year. The mean growth rate of 56% of the tumors was 2.9 mm/year. Glasscock and coworkers followed 34 patients for a mean of 2.4 years. followed 68 elderly patients (mean age, 67.1 years) with acoustic neuromas conservatively for a mean of 3.4 years 71% demonstrated no tumoral growth. The approach to these diagnosed but clinically silent lesions will rely heavily on our understanding of the natural history of these tumors.ĭeen et al. With the widespread use of magnetic resonance (MR) imaging, however, the diagnosis of clinically occult lesions will increase. A large number of clinically silent tumors probably never require medical attention during an individual’s lifetime. Given the disparate data between occult postmortem lesions and clinically apparent lesions, the true incidence of acoustic neuromas is thought to range between these two numbers. However, the 1991 National Institutes of Health Consensus Statement estimated 2,000 to 3,000 new, clinically apparent cases of unilateral acoustic neuromas each year, or an incidence of about one tumor per 100,000 per year. In another temporal bone study, Leonard and Talbot found a 0.8% incidence of occult acoustic neuromas. Schuknecht analyzed 1400 temporal bone specimens and found a 0.57% incidence of occult acoustic neuromas, or about 570 tumors per 100,000 people. Their prevalence and incidence remain unclear. This article reviews the clinical presentation and diagnostic evaluation of acoustic neuromas.Īcoustic neuromas account for about 75% of tumors discovered in the cerebellopontine angle (CPA). Once this lesion is suspected, the appropriate diagnostic tests are vital for treatment planning and pretreatment discussions with the patient. Key Words: acoustic neuroma, audiometry, radiological imaging, sensorineural hearing lossĪ thorough understanding of the clinical manifestations of acoustic neuromas is essential for diagnosis. Its widespread use has led to increasingly earlier diagnosis of acoustic neuromas, including asymptomatic lesions. Magnetic resonance imaging is the diagnostic gold standard. Audiometric testing is useful for diagnostic screening and pretreatment planning. Late findings include brainstem compression, hydrocephalus, and facial paresis. Clinical manifestations include hearing loss, tinnitus, vertigo, dysequilibrium, and cranial nerve neuropathies. While their natural history is not fully understood, a subset of tumors demonstrates significant growth over time, necessitating treatment. Joseph’s Hospital and Medical Center, Phoenix, ArizonaĪcoustic neuromas are the most common cerebellopontine angle tumor in adults. Barrow-ASU Center for Preclinical Imagingĭivision of Neurological Surgery and *Section of Neurotology, Barrow Neurological Institute, St.
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