For a small (<1.5 cm) intracanalicular acoustic neuroma in a 70-year-old with moderate hearing loss and no serviceable hearing, what is the CURRENT recommended management approach?

• A Immediate surgical resection via translabyrinthine approach
• B Stereotactic radiosurgery (Gamma Knife) immediately
• C Fractionated radiotherapy immediately
• D Watchful waiting (serial MRI) initially, with intervention if growth demonstrated ✓

Explanation

Current guidelines (AAO-HNS, British acoustic neuroma guidelines) recommend watchful waiting with serial gadolinium-enhanced MRI (at 6 months, then annually) for small intracanalicular or small cistern tumors, particularly in elderly patients, as many remain stable for years (50-60% show no growth). Active intervention — radiosurgery or surgery — is reserved for documented growth, increasing symptoms, or patient preference. The 'wait-and-scan' approach avoids unnecessary treatment morbidity.

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.