The diagnosis of acoustic neurinoma

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Abstract
The purpose of this study was to assess the comparative contribution of usual investigative methods in achieving an early diagnosis of acoustic neurinoma. An analysis of the records of 49 patients with acoustic neurinoma is presented. Earlier hopes that an audiometric diagnosis would be possible were not borne out. Only 59% of the patients showed the classical pattern of a retrocochlear lesion on detailed audiometric investigations. In 20 patients full audiological investigations could not be performed because the patient was completely deaf or had advanced disease with increased intracranial pressure. Bithermal caloric tests performed on 28 patients showed reduction or total loss of labyrinthine function on the affected side in all patients. Five (18%) of 28 patients showed lumbar CSF protein levels of less than 0.5 g/l. On plain radiography diagnostically positive results were achieved in only 52% of the patients and on tomography 87% of 23 patients showed conclusive evidence of an acoustic neurinoma. Posterior fossa myodil studies and ventriculograms were performed on 45 patients and in each case the diagnosis was confirmed. Tomography and posterior fossa myelography in conjunction with polytomography are the most important investigations and will yield close to 100% accuracy in diagnosis. The clinical features of acoustic neurinoma and their value as aids to diagnosis are considered and an analysis of diagnostic methods and results obtained indicates that the most reliable information can only be obtained by radiological techniques.

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