Treatment planning for patients with acoustic neuroma

Andrew Fishman^1,2,3,4Oskar Rosiak^5*Arnaldo Rivera²Michael Puricelli¹Nenad Zivkovic⁶Jozef Mierzwinski⁷Bojan Markovic⁸Natalija Milisavlevic⁶Radosław Rola⁹Marcin Szymanski⁴

• ¹Department of Pediatric Otolaryngology Head and Neck Surgery, Children's Mercy Kansas City, Kansas City, United States
• ²Department of Otolaryngology Head & Neck Surgery, University of Missouri, Columbia, United States
• ³Department of Otolaryngology, Audiology and Phoniatrics,, Children's Hospital of Bydgoszcz, Bydgoszcz, Poland
• ⁴Department of Otolaryngology-Head and Neck Surgery, Medical University of Lublin, Lublin, Poland
• ⁵Department of Otolaryngology, Polish Mother’s Memorial Hospital Research Institute, Łódź, Poland
• ⁶Department of Neurosurgery, Belmedic Hospital, Belgrade, Serbia
• ⁷Department of Otolaryngology, Audiology and Phoniatrics, Children's Hospital of Bydgoszcz, Bydgoszcz, Poland
• ⁸Department of ORL, Belmedic Hospital, Belgrade, Serbia
• ⁹Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Lublin, Poland

Introduction: Acoustic neuroma (AN) is a benign tumor of the vestibulocochlear nerve, with increasing detection due to improved imaging. Treatment decisions are complex, requiring an individualized approach based on tumor size, location, growth rate, and patient-specific factors such as hearing and vestibular function. Results: Treatment options include observation, microsurgery, and stereotactic radiosurgery. Hearing preservation is prioritized in select cases using middle cranial fossa or retrosigmoid approaches, while translabyrinthine surgery is preferred for larger tumors or disabling dizziness. Stereotactic radiosurgery offers a non-invasive alternative but has variable long-term hearing outcomes and potential tumor regrowth. Vestibular rehabilitation is essential post-treatment, particularly after surgical resection. Discussion: Decision-making depends on patient age, tumor progression, and symptom severity. Younger patients with small tumors may benefit from early intervention to preserve hearing, while older patients with severe imbalance achieve better quality-of-life outcomes with surgery. Stereotactic radiosurgery remains an option for patients unable to undergo surgery, though its long-term efficacy and side effects require careful consideration. A multidisciplinary approach is essential to optimize treatment outcomes. Summary: AN management must be tailored to individual patient profiles. This review integrates current literature and expert clinical experience to guide otolaryngologists, neurologists, and oncologists in treatment planning. Future research should refine treatment algorithms and improve functional outcomes.