Stereotactic radiosurgery is increasingly being used in the treatment of small and medium acoustic neuromas. The rapid return to normal activity and avoidance of an open procedure are attractive alternatives to microsurgery. The treatment aims to prevent further tumor growth, maintain neurological function and minimize the risk of new neurological deficits. Worldwide experience with the technique is increasing and long-term results require careful scrutiny. Treatment protocols are evolving as experience with the technique increases . Careful planning using stereotactic MRI enables precise isodose curves with steep radiation fall-off outside the tumor margin to be used in the treatment of small and medium acoustic neuromas. Doses of between 12 and 16 Gy at the treatment margin and 16-24 Gy at the tumor core are being used. If hearing preservation is sought, doses are at the lower limits of these ranges.
Of 162 consecutive patients followed up for a minimum of 5 years in Pittsburgh, tumor size diminished in 62%, remained static in 33% and showed slow growth in 6%. Normal facial and trigeminal nerve function was evident in 79 and 73%, respectively, at follow-up . Preservation of useful hearing was reported in 50% of the 18 patients with useful pre-treatment hearing treated in Sheffield . In the small number of patients we have operated upon following failed radiosurgery, dissection of the tumor from the facial nerve is more difficult due to increased adherence, particularly at the porus acousticus.
To date, no randomized trial has been performed to compare the treatment options in patients with acoustic neuromas. The indications for radiosurgery are relative and are evolving. Patients with co-existing medical ailments, recurrent tumors, which are very rare in our experience, and neurofibromatosis-2 are all
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