Sporadic acoustic neuroma

Purpose: To date, early diagnosis of vestibular schwannoma is becoming more and more frequent. This involves an increasing number of small tumors with good hearing. Hearing preservation is thus becoming the goal of each therapy of small acoustic neuroma. The aim of this review was to analyze the treatment options for sporadic vestibular schwannoma (observation, radiotherapy, surgery), in terms of long-term cure for the disease with minimal morbidity, in order to ascertain which treatment option offers the best function preservation rates, especially in terms of hearing. Method: Seven hundred and fifty recently published representative case series treated with various options, focusing on hearing preservation, were identified in the PubMed database, and then screened based on parameters preliminarily established. Results: From a critical analysis of the results, some critical issues emerged. As to begin, a proper comparison of hearing outcomes among the various options is impossible. Observation and radiotherapy seem to offer good short-term results, but most studies revealed a significant bias due to the lack of long-term follow up data. As for surgery, the results varied considerably due to differences in surgeons’ expertise, patient selection criteria, and other institutional factors. Conclusions: Hearing preservation, together with hearing rehabilitation in VS is the current most-debated topic in the therapy of sporadic VS. Thus, the need of long-term, high quality and homogenous data in order to analyze and compare the hearing functional outcome within the observation, radiotherapy, and surgery.