Acoustic neuroma historical perspective

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

Acoustic neuroma was first described by Eduard Sandifort , a professor of anatomy in the Netherlands, in 1777. Bilateral acoustic neuroma was first described by Wishart in 1822. He described a patient who became progressively deaf, blind, with uncontrollable vomiting, headaches, and facial jerking. He died at 21 years of age. Sir Charles Bell provided the first known report of a case of Meckel cave neuroma in 1833, demonstrating the relationship of the tumor to the cerebellopontine angle. Sir Charles Ballance successfully removed an acoustic neuroma in 1894, although the patient had right side facial paralysis and trigeminal anesthesia. Since then, tremendous efforts of many surgeons have been continuing to provide surgical approaches to improve outcomes of treatments and decrease side effects of interventions.

• Acoustic neuroma was first described by Eduard Sandifort, a professor of anatomy in the Netherlands, in 1777.^[1]
• Bilateral acoustic neuroma was first reported by Wishart in 1822, in a patient who became progressively deaf, blind, had uncontrollable vomiting, headaches, and facial jerking. The patient died at 21 years of age. Wishart found numerous tumors in the skull at autopsy. He described the following: “The seventh cranial nerve pair was diseased in the same manner; a tumor of the size of a small nut, and very hard, being attached to each of them, just where they enter the meatus auditorius internus.” ^[2]
• In most of the 18th century any surgery within the dura resulted in patient’s death, until understanding the role of bacteria, sepsis and the development of anesthesia was made in late 1800s. Sir Charles Ballance successfully removed an acoustic neuroma in 1894, although the patient had right side facial paralysis and trigeminal anesthesia.
• Early in 1925, Dandy reported, operative mortality in acoustic neuroma was ranging from 67% to 84%. Harvey Cushing, through increased experience and partial, intracapsular removal of the tumor, was able to reduce the mortality rate to 11%.
• Because of the concern of tumor regrowth, Walter Dandy suggested total removal of the tumor by intracapsular enucleation followed by “deliberate, painstaking dissection of the capsule” from the brainstem through a suboccipital approach, which became the standard technique for removing acoustic neuromas for the next 40 years. Although there were improvements in diagnosis and treatment, mortality rate was still high.^[3]
• Dr William House had developed the middle cranial fossa approach for decompensation of the internal auditory canal in 1960. He performed a series of cadaver sections to find a method to expose the cerebellopontine angle through mastoid to preserve the facial nerve, the tympanic membrane, and posterior canal wall which leads to development of translabyrinthine approach.^[4]
• In 1965, when the first international symposium on acoustic neuroma was organized, leading neurosurgeons, otologists, neurologists, and audiologists attended the meeting and covered an expanded range of subjects.
• Over the years, the recognized approaches include: retrosigmoid, middle fossa, and translabyrithine. 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.^[5]

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