Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-19T15:18:44.186Z Has data issue: false hasContentIssue false
  • English
  • Français

Treatment of acoustic tumours in elderly patients: is surgery warranted?

Published online by Cambridge University Press:  29 June 2007

Hans A. W. Ramsay  and
William M. Luxford
Hans A. W. Ramsay*
Affiliation:
Institute Research Fellow 1991–1992 and is a Clinical Teacher, University of Helsinki, Department of Otolaryngology, Helsinki, Finland
William M. Luxford
Affiliation:
The House Ear Institute and House Ear Clinic, Los Angeles, California. The Institute is an affiliate of the University of Southern California School of Medicine
*
Hans Ramsay, M.D., University Hospital/Korvaklinikka, Haartmaninkatu 4 E, SF-00290 Helsinki, Finland
Get access Rights & Permissions [Opens in a new window]

Abstract

Controversy regarding the best and safest treatment of acoustic tumours in elderly patients still exists. These patients may therefore end up having either microsurgical tumour removal, stereotactic radiosurgery or no treatment at all, depending on where the treatment decision is made. We evaluated the results of microsurgery for acoustic tumour removal in 65 patients who were 70 years of age or older. Surgery was performed between 1982 and 1989, using the translabyrinthine approach. Total tumour removal was achieved in 61 patients (94 per cent). No deaths due to surgery occurred. Other than one case of meningitis, there were no serious complications. Seven cases had post-operative CSF leaks, and three required surgery for correction of the problem. Facial nerve function pre-operatively, at the time of discharge and at one year or more post-operatively was compared to that in a younger age group. No differences between the groups were found. Nor was there any significant difference in mean operative time, blood loss, or hospital stay between the older and younger patients.

We believe that total microsurgical tumour removal is the treatment of choice in patients who are in good health, regardless of age. Partial removal is acceptable only if the tumour is adherent to the facial nerve or if vital-sign changes occur during surgery. Other forms of treatment are reserved for cases where surgery is contraindicated or refused by the patient.

Keywords

Cranial nerve neoplasmsvestibular schwannomaAgedMicrosurgeryRadiosurgery
Type
Research Article
Information
The Journal of Laryngology & Otology , Volume 107 , Issue 4 , April 1993 , pp. 295 - 297
Copyright
Copyright © JLO (1984) Limited 1993

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Brackmann, D. E., Kwartler, J. A. (1990) Treatment of acoustic tumours with radiotherapy (Commentary). Archives of Otolaryngology–Head and Neck Surgery 116: 161–162.CrossRefGoogle Scholar
Flickinger, J. C, Lunsford, L. D., Coffey, R. J., Linskey, M. E., Bissonette, D. J., Maitz, A. H., Kondziolka, D. (1991) Radiosurgery of acoustic neuromas. Cancer 67: 345–353.3.0.CO;2-M>CrossRefGoogle Scholar
House, J. W., Brackmann, D. E. (1985) Facial nerve grading system. Otolaryngology Head and Neck Surgery 93: 146–147.CrossRefGoogle ScholarPubMed
House, J. W., Nissen, R. L., Hitselberger, W. E. (1987) Acoustic tumour management in senior citizens. Laryngoscope 97: 129–130.CrossRefGoogle ScholarPubMed
Lunsford, L. D., Linskey, M. E. (1992) Stereotactic radiosurgery in the treatment of patients with acoustic tumours. Otolaryngologic Clinics of North America 25: 471–491.CrossRefGoogle Scholar
Lunsford, L. D., Flickinger, J., Coffey, R. J. L. (1990a) Stereotactic gamma knife radiosurgery: Initial North American experience in 207 patients. Archives of Neurology 47: 169–175.CrossRefGoogle ScholarPubMed
Lunsford, L. D., Kamerer, D. B., Flickinger, J. C. (1990b) Stereotactic radiosurgery for acoustic neuromas (Commentary). Archives of Otolaryngology—Head and Neck Surgery 116: 907–909.CrossRefGoogle Scholar
Nager, G. T. (1969) Acoustic neurinomas: Pathology and differential diagnosis. Archives of Otolaryngology 89: 252–279.CrossRefGoogle ScholarPubMed
National Institute of Health (1991) NIH Consensus Development Conference on Acoustic Neuroma (Summary)December 11-13, 1991.Google Scholar
Nedzelski, J. M., Canter, R. J., Kassel, E. E., Rowed, D. W., Tator, C. H. (1986) Is no treatment good treatment in the management of acoustic neuromas in the elderly. Laryngoscope 96: 825–829.CrossRefGoogle ScholarPubMed
Noren, G., Arndt, J., Hindmarsh, T. (1983) Stereotactic radiosurgery in cases of acoustic neurinoma: Further experiences. Neurosurgery 13: 12–22.CrossRefGoogle ScholarPubMed
Palva, T., Troupp, H., Jauhiainen, T. (1985) Hearing preservation in acoustic neurinoma surgery. Ada Oto-Laryngologica 99: 1–7.CrossRefGoogle ScholarPubMed
Shelton, C., Brackmann, D. E., House, W. F., Hitselberger, W. E. (1989) Middle fossa acoustic tumour surgery: Results in 106 cases. Laryngoscope 99: 405–408.CrossRefGoogle ScholarPubMed
Silverstein, H., McDaniel, A., Norell, H., Wazen, J. (1985) Conservative management of acoutic neuroma in elderly patients. Laryngoscope 95: 766–770.CrossRefGoogle Scholar
Valvassori, G. E., Guzman, M. (1989) Growth rate of acoustic neuromas. American Journal of Otology 10: 174–176.Google ScholarPubMed
Wazen, J., Silverstein, H., Norrell, H., Besse, B. (1985) Preoperative and postoperative growth rates in acoustic neuromas documented with CT scanning. Otolaryngology Head and Neck Surgery 93: 151–155.CrossRefGoogle ScholarPubMed
Wiet, R. J., Young, N. M., Monsell, E. M., O'Connor, C. A., Kazan, R. (1989) Age considerations in acoustic neuroma surgery: The horns of a dilemma. American Journal of Otology 10: 177–180.Google ScholarPubMed
Wiet, R. J., Teixido, M., Liang, J.-G. (1992) Complications in acoustic neuroma surgery. Otolaryngologic Clinics of North America 25: 389–412.CrossRefGoogle ScholarPubMed