I found an interesting article from Neurosurg. Focus / Volume 14 / May, 2003 Management options for acoustic neuroma, the article covers the options available for treatment, and includes a survey in which two scenarios are given, which where actually real cases, of neurosurgeons diagnosed with AN's, and how they would choose to treat themselves. The whole article is very interesting and I recommend any newly diagnosed patient to read it, but I will post only the survey:
(just for clarification, SRS is radiosurgery- gammaknife/cyberknife; resection is surgery; and fractionated radiotherapy (not to be confused with FSR) is generally radiation given over many days or weeks and is not precision like gammaknife/cyberknife)
Survey of Neurosurgeons on Acoustic Neuroma Management.
A survey was mailed to members of the Congress of Neurological Surgeons in July 2002. Six hundred sixty-three surgeons (30%) responded to the survey. There were four questions written on one page. Forty one percent of responders were between the age of 40 and 50years (Table 2). Eighty percent of neurosurgeons (530) surveyed had either performed radiosurgery in a patient with an acoustic neuroma or had referred a patient for neurosurgery.
Survey Case One.
Question: You are a 37-year-old neurosurgeon who presents with mild decreased hearing on one side. You have no tinnitus and no balance problems. Facial function is normal. An MR image reveals an intra-canalicular acoustic neuroma and serial images have demonstrated a small amount of growth. Which management strategy would you choose for yourself? Observation; re-section; SRS; or fractionated radiotherapy? (Fig. 2). Response: The majority of surgeons (283 [43%]) stated that they would choose SRS for management of their small acoustic tumor. Only 122 surgeons (18%) stated that they would choose resection. Fractionated radiotherapy was chosen by 2% of responders. Interestingly, 240 surgeons (36%) stated that they would continue to observe their tumor rather than undergo any specific treatment at the time. It had been stated in the case presentation that serial images had already demonstrated a small amount of growth. This tumor had been observed and was increasing in volume. Nevertheless, approximately one third of responders continued to choose observation for a 37-year-old patient with a small but growing tumor. We evaluated the age of the responding surgeon and compared this to the treatment chosen by that surgeon(Table 2). Across the age groups between 30 and 70 years, at least twice as many neurosurgeons chose SRS for their tumor rather than resection. This is most pronounced inthe younger surgeon age group (30–40 years), in which the number of surgeons choosing SRS over resection was fourfold higher. Observation, however, continued to be chosen by many. Although one might think that an older person might choose radiosurgery over resection, simply to avoid the risks of general anesthesia or the surgical exposure, this did not necessarily appear to be true. This case reflected the care of an actual neurosurgeon who had undergone GKS. He remains well 18 months following his procedure, maintaining a full practice. He has experienced no facial weakness or change in hearing.
Survey Case Two.
Question: You are a 50-year-old neurosurgeon who presents with mild decreased hearing on one side. You have tinnitus but no balance problems. Facial function is normal. An MR image reveals a left acous-tic neuroma. Which management strategy would you choose for yourself? Observation; resection; SRS; or frac-tionated radiotherapy? (Fig. 3).Response: In this scenario, the neurosurgeon had a medium-sized acoustic tumor that indented the middle cerebellar peduncle but did not compress the fourth ventricle.The tumor measured 22 mm in the maximum diameter.The minority of surgeons (6%) recommended continued observation for a tumor of this size. Resection was recommended by 347 surgeons (52%), whereas SRS was chosen by 261 surgeons (39%). Fractionated radiotherapy was only chosen by 3%. When the results were stratified by age, resection was the most popular choice across the groups between the age of 30 and 60 years. Radiosurgery, however, became more popular with advancing age of the survey group, passing resection as the most popular choice when the neurosurgeon was older than age 60 years. It appears that surgeons chose to undergo resection because of the larger volume of the tumor that indented the lateral surface of the brainstem. This patient was also a real neurosurgeon who had undergone SRS. He remains well 18 months after the procedure and the tumor has decreased in size. Facial function remains normal.
CONCLUSIONS
Patients with acoustic neuromas have several treatment options. Large tumors with significant brainstem compression usually require resection. For patients with small or medium sized tumors, SRS has become a common treatment, with excellent reported long-term results. Patients must be comfortable with the concept of tumor control rather than tumor removal. Most seem to be satisfied with this concept, if it allows them to avoid brain surgery. Surgeons should strive to educate their patients with information from the peer reviewed literature. Confusion among patients exists because the information provided by internet sources, newsletters, support groups, and physicians has not always been validated and supported by outcomes data. Although we are asked to provide our opinions, our comments should not be based on myth, conjecture, training bias, or socioeconomic concerns.
http://72.14.207.104/search?q=cache:grylQgTdWqsJ:www.aans.org/education/journal/neurosurgical/may03/14-5-1.pdf+survey+neurosurgeons+radiosurgery&hl=en&start=4
