THE FACIAL nerve is the key that opens the door to early surgical removal of acoustic neuromas.
Cushing was not too concerned with the facial nerve, since partial tumor removal rarely affected the nerve. Dandy, however, by 1925 was dealing with less advanced lesions and correctly advocated total removal of the lesion to prevent the high mortality of recurrence surgery. With these total removals came the problem of facial paralysis.
Diagnostic acumen continued to improve, and by 1950 tumors were being diagnosed at a much less advanced stage than those seen by Dandy.
In 1950, Penneybaker and Cairns recommended a policy of watchful expectation in early acoustic neuromas. Why trade a moderate hearing loss for a facial paralysis, total hearing loss, and possible ataxia? It could be a still more expensive trade to wait until a patient's symptoms became so severe that surgery could not make him any worse. When
House WF, Hitselberger WW. Preservation of the Facial Nerve in Acoustic Tumor Surgery. Arch Otolaryngol. 1968;88(6):655–658. doi:10.1001/archotol.1968.00770010657014
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