The management of acoustic neuromas has been revolutionized by the physicians and scientists at the House Clinic. In the early 1960’s acoustic neuromas were treated utilizing a suboccipital approach without the aid of an operating microscope. At that time the mortality for acoustic neuroma removal in the State of California was 40%. At that time, Dr. William House, a young associate of his brother Howard, was able to diagnose a small acoustic neuroma. The patient was referred to a neurosurgeon and the neurosurgeon recommended that the tumor be observed – a common course of management at that time.
The tumor grew relatively rapidly and was then operated by the suboccipital approach without the aid of magnification. Unfortunately, this young fireman died of the surgical procedure. This had a profound effect upon Dr. William House and at that time he began doing dissections in the laboratory with the aid of magnification and subsequently developed first the middle cranial fossa and then the translabyrinthine approach for removal of acoustic neuromas.
The use of the operating microscope soon became standard practice for all approached for removal of acoustic neuroma. The mortality rate rapidly fell to less than 1% and preservation of facial nerve function became the rule rather than the exception. More recently, preservation of hearing has also become a realistic goal in acoustic tumor surgery.
At the House Clinic and Institute, a surgical team manages these tumors. The team consists of a neurotologist, a neurosurgeon, an internist, the anesthesiologist and then the entire support team of surgical intensive care and clinical nurses who care for the patient during their surgery and hospitalization. We believe that this team approach is important in that it adds the combined expertise of several disciplines to improve patient outcomes.
At the House Clinic all current modalities used for the treatment of acoustic neuromas are employed. In general, we favor surgical removal of the tumor but may employ stereotactic x-ray therapy when indicated. Our indication for stereotactic x-ray therapy are the same as those recommended by the consensus conference of the National Institute of Health, namely a relatively small tumor that is growing in an elderly patient or one whose medical condition is such that it is deemed inadvisable to perform surgical removal. We recommend surgery, however, for the majority of our patients.