Abstract
In acoustic neuroma surgery, preservation of facial and/or hearing functions is desired when tumor resection is required. Today, stereotactic radiosurgery or radiotherapy has become a standard alternative treatment ; therefore, surgical indication is becoming even more stringent. However, unification or standardization of the surgical indication for acoustic neuromas is difficult because each surgeon has different surgical skills, experience, surgical policy, and circumstances for surgery. Commonly consented surgical indications for acoustic neuromas are : a large tumor that is oversize for application of stereotactic radiation therapy, cystic tumor, rapidly growing tumor, and a tumor for which consideration is given to surgical hearing preservation in a young patient. The important key elements to achieve good surgical results are : a lateral suboccipital retrosigmoid approach, a surgical policy that does not always adhere to total removal, continuous facial nerve monitoring, full and sufficient opening of the posterior wall of the internal auditory canal, 7 gates of surgical resection, piercing and lifting a tumor with a dissector, and techniques for hemostasis.
