There is no question that total removal is the treatment of choice in acoustic tumor surgery. However, at the time of surgery, there are a number of considerations which occasionally make total removal inadvisable.
In our middle fossa series, there were six total removals and four partial removals. In the posterior fossa series, there was one total removal and two partial removals. In the translabyrinthine series, there were 26 total removals and 17 partial removals. In 1925, Dandy1 recommended total removal of acoustic tumors at the initial operation in all cases. He noted, as have other surgeons, that the second operation for acoustic tumor had a high mortality rate. This was believed to be due primarily to adhesions that developed in the posterior fossa which obscured the surgical planes and increased the bleeding, thus making injury to such structures as the cerebellum and brain stem much more likely. Dandy's
HOUSE WF, HITSELBERGER WE. Total Versus Subtotal Removal of Acoustic Tumors. Arch Otolaryngol. 1964;80(6):751–752. doi:https://doi.org/10.1001/archotol.1964.00750040767020
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