Suboccipital resection of a medial acoustic neuroma with hearing preservation

Abstract

BACKGROUND Many reports indicate that acoustic neuromas greater than 2.0 cm should be removed without hearing preservation attempted, even if hearing is present preoperatively. These studies advocate a translabyrinthine approach because the likelihood of hearing preservation is low. Medial acoustic neuromas, unlike the more common lateral tumors that involve the internal auditory canal, originate medial to that portion of the eighth nerve complex where the cochlear and vestibular nerves are fused. This anatomical feature suggests that these tumors may be amenable to resection with hearing preservation. METHODS A patient with a 3.5 cm medial acoustic neuroma and useful preoperative hearing is presented. RESULTS Gross total tumor removal with functional hearing was achieved after a two-stage procedure using a suboccipital approach. CONCLUSION Based on the anatomico-pathologic features in this case, we believe that, if a patient has reasonable preoperative hearing (speech discrimination score > 70%) and a medial acoustic neuroma, an approach to preserve hearing should be considered regardless of tumor size.