McMenomey and Kaylie propose microsurgery as the best therapy for acoustic neuromas, and for most patients with this tumor, I agree with their conclusion. The microsurgical techniques used today for tumor removal have been practiced for more than 35 years, and the advances in imaging techniques and intraoperative cranial nerve monitoring have helped to improve overall results. Numerous large studies of surgical results have demonstrated comparable and predictable outcomes in experienced hands. For small tumors (<20-mm extension into the cerebellopontine angle), the results of facial function and hearing preservation are comparable or superior to those reported by radiosurgery. Cerebrospinal fluid leaks are an occasional postoperative problem but can be managed conservatively in most cases. Only 2% of patients must be returned to the operating room for surgical closure of the leak. Major complications such as meningitis, stroke, intracranial bleeding, or hydrocephalus are rare, and the mortality rate is less than 1%.
Newton J. Coker, MD
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