Managing acoustic neuroma: Observation, surgery or radiation?

The management of acoustic neuromas has been controversial, with a range of management options available and varying from centre to centre. Despite the lack of guidelines, there does appear to be a consensus that small, asymptomatic tumours should initially be observed with serial scanning. When tumours are large and growing, and symptoms are developing, the best approach may be microsurgical resection, although recently radiation has been recognized as a minimally invasive alternative to control the growth of the tumour with decreased morbidity. Patients need to be supported by nurse specialists throughout the decision-making process.