Acoustic Neuroma: From Evidence to Treatment Franco Trabalzini

Acoustic Neuroma: From Evidence to Treatment
Franco Trabalzini
Otology and Skull Base Surgery Department, Siena University Hospital, Italy

There have been great developments in both diagnosis and management of acoustic neuromas since Sir Charles Ballance first operated on the cerebellopontine angle in 1894. The pioneering of the retrosigmoid and sub-occipital approaches by Cushing and Dandy, and the development of the translabyrinthine approach by Panse, Quix, and later House, provided therapeutic options for a previously fatal condition. Improved imaging including MRI permitted earlier diagnosis of smaller lesions, allowing the clinician time to observe these tumors. Subsequently, radiosurgery and the middle cranial fossa surgical approach offered preservation of function and have both complicated the decision-making and increased the controversy in management. The modern approach to these tumors therefore requires the clinician to consider many variables in selecting a treatment strategy, including size, location, and patient comorbidity. This talk will review the evolving history of and multi-disciplinary decision-making needed for acoustic neuroma treatment, as well as the surgical techniques necessary for their successful removal.