Acoustic neuromas (AN) are schwann cell-derived tumors that commonly arise from the vestibular portion of the eighth cranial nerve also known as vestibular schwannoma(VS) causes unilateral hearing loss, tinnitus, vertigo and unsteadiness. In many cases, the tumor size may remain unchanged for many years following diagnosis, which is typically made by MRI. In the majority of cases the tumor is small, leaving the clinician and patient with the options of either serial scanning or active treatment by gamma knife radiosurgery (GKR) or microneurosurgery. Despite the vast number of published treatment reports, comparative studies are few. The predominant clinical endpoints of AN treatment include tumor control, facial nerve function and hearing preservation. Less focus has been put on symptom relief and health-related quality of life (QOL). It is uncertain if treating a small tumor leaves the patient with a better chance of obtaining relief from future hearing loss, vertigo or tinnitus than by observing it without treatment. In this paper we review the literature for the natural course, the treatment alternatives and the results of AN. Finally, we present our experience with a management strategy applied for more than 30 years.
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