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Reynaldo Castillo, Clark Watts and Morris Pulliam

A coustic neuromas account for 8% to 10% of all intracranial tumors 10, 12 and 71% of all tumors in the region of the cerebellopontine angle. 5 They usually present with gradual onset of unilateral hearing loss and subsequent involvement of adjacent cranial nerves and other structures. 7, 11 Development of sudden hemorrhage as an acute symptom is unusual. We present a case in which an acoustic neuroma was associated with spontaneous hemorrhage. The role of computerized tomography (CT) in the diagnosis of these lesions is discussed. Case Report This

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Stephen G. Harner and Michael J. Ebersold

T he management of acoustic neuromas has undergone a number of changes during the past 25 years. Improvements in audiometry, electronystagmography, multidirectional tomography, computerized tomography (CT), and brain-stem evoked response audiometry have dramatically expanded diagnostic capabilities. These changes, combined with increased physician and patient awareness, have allowed the identification of tumors early, when they can be removed more easily. Refinements in anesthetic agents and improved monitoring have decreased the operative risks. Additionally

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Stephen J. Haines and Samuel C. Levine

G adolinium (Gd)-enhanced magnetic resonance (MR) imaging has revolutionized the diagnosis of acoustic neuroma. We have previously reported our finding that this technique is the most sensitive test for acoustic neuroma. 11 While intracanalicular tumors could previously be identified by air-contrast computerized tomography (CT) cisternography, the ability of Gd-enhanced MR imaging to identify heretofore invisible tumors restricted to the internal auditory canal has increased the frequency with which such tumors are diagnosed. We report our experience with

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Sheldon Baum, Alan B. Rothballer, Felix Shiffman and Rita F. Girolamo

. 4 These delayed scans have resulted in the visualization of tumors that would otherwise escape detection on scans performed shortly after injection of the radionuclide. Despite these improvements, the usefulness of scanning techniques for visualizing and diagnosing acoustic neuromas is still not generally appreciated. This is due partly to the poor reputation enjoyed by brain scanning for demonstrating posterior fossa lesions in general, especially prior to the introduction of 99m Tc-sodium pertechnetate. Even with the more widespread use of this radionuclide

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Simone A. Betchen, Jane Walsh and Kalmon D. Post

R ecently a body of literature has arisen in which the QOL after surgery for acoustic neuromas is evaluated from the patient's perspective. Although it has been established that patients after acoustic neuroma surgery have a lower QOL score than population norms, no correlations that may explain this result have been found. 1, 6, 9, 13, 16, 18, 19, 21, 23, 27 Although advances in surgical procedures have reduced mortality and morbidity rates, there remain significant postoperative complaints. These postoperative symptoms, as reported in the literature

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Steven D. Chang, Joseph Poen, Steven L. Hancock, David P. Martin and John R. Adler Jr.

S tereotactic radiosurgery is an accepted treatment for selected small and moderately sized acoustic neuromas. 4, 5, 9, 18, 19, 21, 26 One series in which there was a follow-up period lasting longer than 15 years showed that control of these radiosurgically treated tumors appears durable. 30 The principal advantage of stereotactic radiosurgery for treating acoustic neuromas is the noninvasive nature of the treatment and the modest rate of treatment-related morbidity. Nevertheless, loss of hearing occurring between 3 and 9 months posttreatment is a well

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Michael T. Selch, Alessandro Pedroso, Steve P. Lee, Timothy D. Solberg, Nzhde Agazaryan, Cynthia Cabatan-Awang and Antonio A. F. Desalles

A coustic neuromas are benign tumors arising from Schwann cells lining the vestibular branch of the eighth cranial nerve. Their histological appearance belies a potentially aggressive clinical course. Unchecked local growth results in compression of the brainstem and adjacent cranial nerves. 6 Resection has represented the standard of care for patients with acoustic neuromas. 9 In recent surgical series local relapse rates of less than 1% have been reported following complete tumor removal. 17, 18, 43, 46 Despite advances in microsurgery, however, removal

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Masao Tago, Atsuro Terahara, Keiichi Nakagawa, Yukimasa Aoki, Kuni Ohtomo, Masahiro Shin and Hiroki Kurita

R ecently stereotactic radiosurgery has been established as one of the treatments of choice for acoustic neuroma. The advantage of this procedure is its noninvasive nature and the modest incidence of treatment-related morbidity. Many articles on tumor control and clinical status after irradiation, including long-term outcomes, have been published in which low incidences of tumor growth and low complication rates have been reported. 5, 7, 10–14, 17, 18, 21–23, 27, 29 Late neurological deficits affecting facial, acoustic, and trigeminal nerves after

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Taemin Oh, Daniel T. Nagasawa, Brendan M. Fong, Andy Trang, Quinton Gopen, Andrew T. Parsa and Isaac Yang

A coustic neuromas (vestibular schwannomas) are categorized as benign, extraaxial brain tumors ( Fig. 1 ) developing near the internal auditory canal, typically with involvement of the cerebellopontine angle. 32 , 53 , 60 , 130 , 143 Advances in treatment modalities have popularized the application of less invasive management methods such as radiotherapy and radiosurgery, 100 , 138 which carry high efficacy and low morbidity. 31 , 53 , 57 , 86 , 87 , 100 , 101 , 107 However, many acoustic neuromas, particularly those that are large in size, necessitate

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Christian Strauss, Barbara Bischoff, Mandana Neu, Michael Berg, Rudolf Fahlbusch and Johann Romstöck

T he prognostic value of BAEP monitoring during acoustic neuroma surgery for hearing preservation is well recognized. Stable waves during surgery, in particular Wave V, indicate hearing preservation; abrupt loss and progressive irreversible loss of these waves are both associated with anacusis. 7, 14, 15, 18, 19, 30 Gradual reversible loss, which is described as a single or repeated transient absence of wave components ( Fig. 1 ) carries a considerable risk for postoperative hearing fluctuation and delayed hearing loss. 19, 28 In a previously published