Article
Surgical treatment of large acoustic neurinomas in the elderly
Die chirurgische Behandlung größerer Akustikusneurinome bei älteren Patienten
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Authors
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Theodoros Kombos
- Neurochirurgische Klinik, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin
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O. Süss
- Neurochirurgische Klinik, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin
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M. Brock
- Neurochirurgische Klinik, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin
| Published: | April 23, 2004 |
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Outline
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.
