A 40-year-old presents with unilateral progressive SNHL, tinnitus, and disequilibrium. MRI shows a 2.5 cm enhancing mass in the cerebellopontine angle (CPA) compressing the brainstem. Gadolinium MRI shows a 'ice-cream on cone' appearance. Which is the most appropriate primary management according to current guidelines?
- A Wait-and-scan policy for all CPA tumors regardless of size
- B Surgical excision (retrosigmoid, translabyrinthine, or middle fossa approach) given size >2 cm with brainstem compression ✓
- C Stereotactic radiosurgery (Gamma Knife) as first-line for any size
- D Bevacizumab chemotherapy
Explanation
For acoustic neuromas (vestibular schwannomas) >2 cm with brainstem compression or significant growth, surgical resection is the preferred management. The 'ice-cream on cone' appearance on MRI (broad-based tumor in IAC with CPA extension) is characteristic. Approaches include translabyrinthine (no hearing preservation, best facial nerve visualization), retrosigmoid (possible hearing preservation), or middle fossa (small intracanalicular tumors). Wait-and-scan is appropriate for small (< 1.5 cm) tumors in elderly patients. Gamma Knife is suitable for tumors <3 cm without brainstem compression.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.