A patient with acoustic neuroma (vestibular schwannoma) is found to have a 2.5 cm tumour in the cerebellopontine angle with involvement of the internal auditory canal and serviceable hearing (Gardner-Robertson grade I). The most appropriate management strategy is:

• A Wait-and-scan policy with annual MRI
• B Middle fossa craniotomy for hearing preservation surgery
• C Translabyrinthine surgery accepting sacrifice of hearing
• D Stereotactic radiosurgery (Gamma Knife) ✓

Explanation

A 2.5 cm vestibular schwannoma with serviceable hearing (GR grade I: speech discrimination score >70% and PTA ≤50 dB) in an appropriately aged patient is an excellent candidate for stereotactic radiosurgery (Gamma Knife or CyberKnife). Radiosurgery provides tumour growth control in >90% of cases, with hearing preservation rates of 50–70% at this size. For tumours >3 cm causing brainstem compression, surgery is preferred. The middle fossa approach preserves hearing but is more suitable for smaller (<1.5 cm) intracanalicular tumours.

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.