Acoustic neuromas in the elderly

Objective: To determine if an "observation" protocol with serial scanning is a safe and effective management paradigm for acoustic neuromas in the elderly. Study Design: A retrospective case review was performed. Setting: This study was performed in an academic, tertiary care center. Patients: Forty-one patients over the age of 65 years were identified with the primary diagnosis of unilateral acoustic neuroma, without prior treatment or observation. Intervention: The patients were followed with serial, gadolinium-enhanced magnetic resonance imaging (MRI) scans performed at 6 months and then yearly, if no significant growth occurred. Main Outcome Measures: The patients were monitored for tumor growth, cranial nerve deficits, and hydrocephalus. Results: The patients were followed for an average of 3.5 years (range, 6 months to 9 years). The average tumor size at presentation was 1.14 cm, with a range of growth rates from 0 to 1.2 cm per year. Twenty-one patients demonstrated tumor growth at an average rate of 0.322 cm per year. Only five patients (12%) required further intervention. Three patients underwent translabyrinthine excision, and two patients were treated with radiation. No patients developed significant complications during the observation period. Conclusions: Acoustic neuromas in the older population can be managed safely using serial MRI scanning. No correlation could be made between initial tumor size and subsequent growth rate.