RESUMO
The wide availability of gadolinium-enhanced magnetic resonance imaging (MRI-Gd) has led to the discovery of an increasing number of small and less symptomatic acoustic neuromas in elderly patients. We conducted a retrospective study in order to obtain data on outcomes and complications associated with different management strategies that would be useful in establishing a management guideline. We identified 44 patients aged 65 to 77 years with acoustic neuromas who had been managed with either surgery or simple observation with MRI-Gd imaging. Of the entire group, 36 patients had tumors larger than 1 cm, and they underwent surgery (most via the translabyrinthine approach). Complete removal of the tumor was achieved in 34 of these patients (94.4%). At the 1-year follow-up, grade VI facial nerve paralysis was evident in only two of 35 evaluable patients (5.7%). Postsurgical complications occurred in five patients (13.9%), including one death. The remaining eight patients had tumors 1 cm or smaller, and they were managed with periodic MRI-Gd scanning. At the 5-year follow-up, no tumor growth was seen in six of these patients. The other two patients exhibited a tumor growth rate of less than 2 mm per year. No patient in the observation group required surgical intervention.
Assuntos
Neuroma Acústico/diagnóstico , Neuroma Acústico/cirurgia , Fatores Etários , Idoso , Biópsia por Agulha , Paralisia Facial/epidemiologia , Paralisia Facial/etiologia , Feminino , Gadolínio DTPA , Perda Auditiva Neurossensorial/epidemiologia , Perda Auditiva Neurossensorial/etiologia , Humanos , Incidência , Itália/epidemiologia , Imageamento por Ressonância Magnética/métodos , Masculino , Monitorização Fisiológica , Neuroma Acústico/epidemiologia , Complicações Pós-Operatórias/diagnóstico , Prognóstico , Intensificação de Imagem Radiográfica , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: To assess the potential benefit of the MXM auditory brainstem implant for patients with neurofibromatosis type 2. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral centers. PATIENTS: Fourteen patients with neurofibromatosis type 2 and bilateral acoustic neuromas underwent implantation with the MXM auditory brainstem implant during surgery to remove the second-side tumor. RESULTS: There were no complications related to the auditory brainstem implantation. Auditory sensations were present for 12 of 14 patients (86%). Global results indicated an improved quality of life for the patients receiving auditory sensations, in part because of their auditory orientation within the environment. Eighty-nine percent of patients tested with an open-set sentence test demonstrated enhancement of speech understanding as a result of lip-reading improvement when auditory brainstem implant sound was combined with lip-reading. A few patients (36%) had some speech understanding in sound-only mode. One patient was able to have limited phone conversations. CONCLUSION: These results indicate that significant auditory benefit can be derived from the MXM auditory brainstem implant.
