Subtotal Resection of Large Acoustic Neuromas With Possible Stereotactic Radiation Therapy

The current standard treatment of a large tumor of the balance nerve (acoustic neuroma or
vestibular schwannoma) is surgical resection. Complete removal of such tumor is associated
with significant risks of hearing loss and facial paralysis whereas incomplete removal of the
tumor is associated with significant risks of regrowth. Stereotactic radiation is a well
accepted therapy aiming at stopping the growth of smaller acoustic neuromas before their
sizes become large enough to cause problems. The purpose of our study is to determine whether
the combination of subtotal resection followed by stereotactic radiation of the remnant can
control large acoustic neuromas without the significant risks associated with complete
resection.

Inclusion Criteria:

- Adult patients with acoustic neuromas the widest diameter of 2.5 cm or larger at the
cerebellopontine angle are eligible for this trial.

- Patients that are deemed good surgical candidates based on age, general health,
genetic predispositions, and hearing in contralateral side would be included as the
subjects of this trial.

- Although we would include patients with neurofibromatosis II in this trial,
considering their genetic predisposition for recurrence, we would analyze their
outcome as a separate group.

Exclusion Criteria:

- Patients who have received any form of treatment of their acoustic neuromas prior to
enrollment in the study including surgery or radiation therapy.