gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Surgical treatment of large acoustic neurinomas in the elderly

Die chirurgische Behandlung größerer Akustikusneurinome bei älteren Patienten

Meeting Abstract

Suche in Medline nach

  • corresponding author Theodoros Kombos - Neurochirurgische Klinik, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin
  • O. Süss - Neurochirurgische Klinik, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin
  • M. Brock - Neurochirurgische Klinik, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocMI.02.10

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0255.shtml

Veröffentlicht: 23. April 2004

© 2004 Kombos et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Large acoustic neurinomas are usually associated with loss of hearing and severe neurological symptoms, thus resulting in a reduction in quality of life. Such tumours often indent the brainstem and the cerebellum, and their surgical management is associated with increased intraoperative risk. Aged patients are a special group having a high mortality and morbidity rate due to the frequent presence of systemic diseases. Consequently, conservative management is recommended. This, however, extends the suffering of the patient. Gamma-knife neurosurgery has been able to slow or arrest the growth of small tumours, however, the management of large neurinomas remains a problem.

Methods

The outcome of 29 elderly patients (above 65 years) with large acoustic neurinomas (larger than 3 cm) was studied. All patients were operated on via the suboccipital approach. Facial function was evaluated by the House and Brackmann (H&B) scale. Hearing function was assessed by audiometry. Follow-up was between 12 and 72 months.

Results

Complete tumour removal was achieved in 21 (72.4%) patients and subtotal removal in 8 (27.6%). Facial nerve function was normal (H&B Grade 1) pre-operative in 15 cases, H&B Grade 2 in 5 and H&B Grade 3 in 9 patients. Immediate post-operative deterioration of the facial function was observed in 20 patients, which resolved to normal in 13 cases at the follow-up. In the 8 patients with subtotal tumour removal, facial function remained unchanged. Post-operative complications were: pneumonia (two case), sepsis (one case) and infarction of the brain stem (two case). Twenty four (82.7%) patients were independent of nursing assistance at the time of discharge from the hospital and 26 (89.6%) at the time of the follow-up examination.

Conclusions

Surgical removal is the treatment of choice for this group of patients. Advances in surgical technique, anesthesia and perioperative care have dramatically reduced both operative morbidity and mortality so that old age per se is not anymore a contraindication for surgery. Since acoustic neurinomas are slow growing benign tumours the extent of the tumour removal must be individually planned.