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We present our experience with 83 patients with acoustic neurinomas (January 1988 to November 1996); 81 patients underwent surgery and 2 patients with intracanalicular neurinomas received conservative therapy due to their advanced age (1 case) and patient's option (1 case). The surgical approach was retrosigmoid/ trasmeatal and the goal was total removal in one procedure with preservation of facial and cochlear nerves. Radical removal of lesion was attempted in 79 cases and it was possible in 77 patients. Subtotal tumor resection was planned in 2 cases. Facial nerve function (grades 1 to III, House and Brackman) was preseved in 90% and hearing in 58% of those with preoperative hearing. Three patients died due to postoperative complications. Early diagnosis of acoustic neurinomas is the most important factor in the prognosis and is one of the most important conquest of neurophysiology and modern neuroimaging. The management of these patients still present many controversial points. This article presents the diagnostic procedures used for acoustic neurinomas, the advantages and disadvantages of the different surgical approaches and the alternative management of these lesions.

We present our experience with 83 patients with acoustic neurinomas (January 1988 to November 1996); 81 patients underwent surgery and 2 patients with intracanalicular neurinomas received conservative therapy due to their advanced age (1 case) and patient's option (1 case). The surgical approach was retrosigmoid/ trasmeatal and the goal was total removal in one procedure with preservation of facial and cochlear nerves. Radical removal of lesion was attempted in 79 cases and it was possible in 77 patients. Subtotal tumor resection was planned in 2 cases. Facial nerve function (grades 1 to III, House and Brackman) was preseved in 90% and hearing in 58% of those with preoperative hearing. Three patients died due to postoperative complications. Early diagnosis of acoustic neurinomas is the most important factor in the prognosis and is one of the most important conquest of neurophysiology and modern neuroimaging. The management of these patients still present many controversial points. This article presents the diagnostic procedures used for acoustic neurinomas, the advantages and disadvantages of the different surgical approaches and the alternative management of these lesions. Apresentamos nossa experiência no tratamento de 83 pacientes com neurinomas do acústico (Janeiro-1988 a Novembro-1996). Cirurgia foi realizada em 81 pacientes e tratamento conservador (idade avançada e escolha do paciente) em 2 casos de neurinomas intracanalicures. O objetivo da cirurgia foi ressecção radical com preservação dos nervos facial e coclear. Em 77 de 79 pacientes foi obtida remoção total. Em 2 casos foi proposta ressecção sub-total devido às más condições clínicas (1 paciente) e por tratar-se de neurofibromatose tipo 2 com lesão dos nervos facial e coclear do outro lado (1 paciente). Preservação do nervo facial (grau I a III, House e Brackman) foi possível em 90% dos casos com função facial pre-operatória normal. Dos 12 pacientes que apresentavam audição no pré-operatório, 7 mantiveram a audição. Ocorreram 3 óbitos no pós-operatório imediato. As vantagens e desvantagens dos acessos cirúrgicos mais utilizados na cirurgia do neurinoma do acústico são demonstradas. O fator mais importante no prognóstico desses pacientes é o diagnóstico precoce, possível com o desenvolvimento de novos métodos neurofisiológicos e neurorradiológicos. O tratamento no entanto pode apresentar algumas controvérsias, variando desde o simples acompanhamento clínico à remoção cirúrgica ou o uso de radiocirurgia.