An acoustic neurinoma is the most common tumor of the cerebello­pontine angle. Advancements in surgery of the cerebellopontine angle are directly reflected in the history of improvements used in both the diagnosis and treatment of acoustic neurinomas.

Sir Charles Ballance performed the first successful removal of an acoustic neurinoma in 1894. The tumor was approached through a suboccipital craniectomy and was removed by blunt finger enucleation. Cushing subsequently developed a subtotal intracapsular technique, which markedly decreased the operative mortality. Walter Dandy accomplished the first complete resection of an acoustic neurinoma in 1917. Dandy, in 1925 described what now serves as the basis for the current operative approach. He outlined a technique utilizing a unilateral suboccipital craniectomy with internal decompression of the tumor and stressed the importance of unroofing the internal auditory meatus for complete resection. Givre and Olivecrona pioneered preservation of the facial nerve during removal of acoustic tumors. Rand and Kurze reported preservation of the cochlear as well as the facial nerve in 1968.

Developments in microsurgical technique and early diagnosis through computed tomography (CT) and magnetic resonance imaging have resulted in the detection of smaller tumors that can be removed with more reliable preservation of cranial nerve function. The use of intraoperative auditory evoked potential monitoring to help preserve hearing and the use of direct intraoperative seventh cranial nerve stimulation has also played an important role in the successful resection of acoustic tumors. These advances in diagnostic and surgical techniques used for the treatment of acoustic neurinomas have also led to a progressively lower morbidity and mortality for the resection of all cerebellopontine angle lesions.

 

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