Title: Small Acoustic Neuromas: Monitoring the Growth Rate by MRI.

Authors: Modugno GC, Pirodda A, Ferri GG, Fioravanti A, Calbucci F, Pezzi A, Ceroni AR, Pirodda E
Location: ENT Department, University of Bologna, Policlinico "S. Orsola-Malpighi", Bologna, Italy

Source: Acta Neurochir (Wien) 1999 Oct 18;141(10):1063-1067


In a proportion of small acoustic neuroma patients, monitoring with magnetic resonance imaging shows no volumetric increase of tumour size over the years. The object of the study was to identify some indications for the clinical choice between immediate surgery (with the related risks) and watchful waiting. We performed a retrospective study of 47 non-surgically-treated patients affected by acoustic neuroma and monitored by gadolinium-enhanced MRI between January 1990 and February 1999. Six clinical variables (tumour size, sex, age, initial symptoms, ABR pattern and duration of the symptoms) were examined by univariate analysis. Chi-square test and variance analysis were performed to evaluate the statistical significance. In 30/47(63.8%) cases, no growth was observed during the entire period of follow-up. In the remaining 17/47 (36.2%) patients, a volumetric increase was detected, most often within the first year of observation. The clinical factors examined did not significantly correlate with growth. Despite the relatively short period of observation, we believe that immediate surgery does not need to be considered mandatory for small acoustic neuromas, even in young patients. However the irregular behaviour ofthe tumour underlines the importance of monitoring with MRI at least once a year.

Inez's note: This paper omitted the other alternative to "immediate surgery and watchful waiting" which is radiation. And may also I add that "no growth" is not the end-all; the 8th cranial nerve can still atrophy due to pressure exerted by the tumor.

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