1/3. Is preservation of hearing in acoustic neuroma worthwhile?In a series of 300 translabyrinthine removals of acoustic neuromas, comprising almost all tumours operated on in denmark during a period of 10 years, the preoperative hearing in the tumour ear and in the contralateral ear was analysed in 72 patients with tumours smaller than 2 cm in extrameatal diameter. These patients constitute likely candidates for a hearing preserving operation via the suboccipital approach. In the tumour ear in 4 patients there was a pure-tone average (PTA) of 0-20 dB and a discrimination score (DS) of 81-100%. Applying this criterion to the whole series, 1% of the patients would be candidates for a hearing preserving procedure. Changing the criterion to a PTA of 0-40 dB and a DS of 61-100%, the number of candidates would increase to 8 patients (3%), and with a PTA of 0-50 dB and a DS of 51-100% 14 candidates (5%) would have been found. In all of these patients, contralateral hearing was normal (SRT 0-20 dB, DS 95-100%). Since preservation of hearing would be achieved in only half of those subjected to suboccipital removal and since the hearing retained in patients with successful operations is generally poorer than the preoperative level, the number of patients obtaining serviceable hearing is so modest that preservation of hearing cannot be considered an argument in favour of suboccipital tumour removal. It should be borne in mind that contralateral hearing is normal in these patients and that, according to most reports, the mortality rate is higher and paralysis of the facial nerve more frequent with the suboccipital approach than with the translabyrinthine procedure.- - - - - - - - - - ranking = 1keywords = acoustic neuroma, neuroma (Clic here for more details about this article) |
2/3. Cochlear deafness in the presentation of a large acoustic neuroma.It is exceptional for a large tumour, as presented, to present a cochlear pattern of hearing loss. Only a rigid adherence to a battery of audiological, vestibular and radiological tests can exclude neuroma. The possibility of hearing conservation in neuroma surgery (Clemis et al., 1981) demands further understanding of the mechanism of cochlear damage produced by CP angle tumours.- - - - - - - - - - ranking = 0.84386733734863keywords = acoustic neuroma, neuroma (Clic here for more details about this article) |
3/3. Some uncharacteristic clinical signs and symptoms of acoustic neuroma.OBJECTIVE: The most common initial symptoms of the acoustic neuroma are unilateral hearing loss that evolves gradually, tinnitus, and unsteadiness. However, atypical presentations may sometimes occur, more often with a small intracanalicular neuroma or with a large medial neuroma placed in the cerebellopontine angle. RESULTS: In our group of 51 patients suffering from acoustic neuroma, atypical presentations were observed in 9 cases (17.6%). Two patients had normal hearing function but reported tinnitus; two patients reported sudden hearing loss, with partial recovery; two patients had a history of fluctuating hearing loss; two patients reported neurologic symptoms (one reported trigeminal paresthesia and the other had a history of trigeminal paresthesia and recurrent headache); and one patient reported profound hearing loss for many years and the recent onset of unsteadiness. CONCLUSION: patients with these atypical presentations have to undergo a diagnostic evaluation for acoustic neuroma and must be evaluated with BAEPs and then with gadolinium-enhanced MRI.- - - - - - - - - - ranking = 1.4438673373486keywords = acoustic neuroma, neuroma (Clic here for more details about this article) |