Chapter 21 : Acoustic tumours

The fascination that acoustic neuromata have always held for the otolaryngologist originates not only from his conviction that the early diagnosis of the condition at the 'otological' stage is his prerogative, but also that their expeditious surgical removal is greatly enhanced by his traditional knowledge of temporal bone and facial nerve anatomy, and of microsurgical technique. In a sense, the internal auditory meatus is a meeting point between the territories of the neurosurgeon and the otologist, and like other such disputed zones is fraught with danger and pitfalls for the unwary. Where surgical disciplines do abut, there has tended to be a danger in the past for both to deal less than adequately with problems of management, and certainly in the case of lesions of the cerebellopontine angle, it has become increasingly apparent over the past two decades that the high ideals of early diagnosis, total tumour removal, low mortality and morbidity, preservation of the facial nerve and occasionally useful hearing, can only come about if otologist and neurosurgeon work together for the good of the patient.