Acoustic neuroma historical perspective

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]


Bilateral acoustic neuroma was first discovered by Wishart in 1922.[1]

Historical Perspective

  •  The first case of acoustic neuroma that has been reported by Sandifort, as stated by House and Luetje,in 1777[2].
  • In the most of the 18th century any surgery within dura eventuate in patient death, until understanding the role of bacteria, sepsis and development of anesthesia has been made in late1800s, Sir Charles Ballance successfully removed an acoustic neuroma in 1894, although the patient had right side facial paralysis and fifth-nerve anesthesia, but the patient was alive and well, he reported.
  • Early in 1925 Dandy reported, operative mortality in acoustic neuroma was ranging from 67% to 84%, which it was extremely high. Harvey Cushing through increased experience and partial, intracapsular removal of the tumor was able to reduce the mortality rate to 11%.
  • Since of concerns of tumor regrowth, Walter Dandy suggested total removal of the tumor by intracapsular enucleation followed by “deliberate, painstaking dissection of the capsul” from the brainstem through a suboccipital approach, which became the standard technique for removing acoustic neuromas for the next 40 years[3].
  • The classical suboccipital approach was used and remained standard of care until the early 1960s.
  • Although there were improvements in diagnosis and treatment, mortality rate was still high.
  • In 1960 when Dr William House first became interested in acoustic neuroma the mortality rate for small tumor was 4.5% and 22.5% for large tumors.
  • By this time, Dr house had developed the middle cranial fossa approach for decompensation of the internal auditory canal for advanced otosclerosis.
  • Dr William House performed a series of cadaver sections to find a method to wxpose the CPA (cerebellopontine angle) through mastoidwithbthe aid of surgical microscope, a dental drill, and suction irrigation, he was able to devise a method to preserve the facial nerve, the tympanic membrane, and posterior canal wall which leads to development of translabyrinthine approach.
  • In July, 1963, Dr William Hitselberger began to work with Dr House. They began using the translabyrithine procedure on a routine basis for tumor of all sizes.
  • In 1964 they were published a series of 53 patients whom underwent subtotal removal.
  • Facial preservation, however, became routine and the mortality rate greatly reduced.
  • In 1965 when the first international Symposium on Acoustic Neuroma was organized, for 5 days leading neurosurgeons, otologists, neurologists, and audilogists attended the meeting and covered a expanded range of sujects.
  • Over the years, it has become recognized all approaches include: retrosigmoid, middle fossa, and translabyrithine are valuable and the approach had to be selected depending on the size and location of the tumor as well as patient’s general condition and preoperative hearing condition.[1]


  1. 1.0 1.1 Welling DB (1998). "Clinical manifestations of mutations in the neurofibromatosis type 2 gene in vestibular schwannomas (acoustic neuromas).". Laryngoscope. 108 (2): 178–89. PMID 9473065. 
  2. House WF, Luteje CM (1979). "Acoustic Tumors". Baltimore University Park Press. 4. 
  3. Rosenberge, Seth (2000). "Natural history of acoustic neuromas". The Laryngoscope.