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This report discusses a combined neurosurgical-otologic team approach to the management of 16 consecutive suspected VIII nerve neurinomas, all operated via the suboccipital route. A suboccipital craniectomy is done with the patient in the prone position. Dissection for all size tumors began with exposure of the internal auditory canal to the transverse crest with dissection of the neurinoma from the VII and VIII cranial nerves beginnin in the lateral most osterior portion of the internal auditory canal. There was one death and one cerebrospinal iuid (CSF) leak. Total tumor removal was accomplished in 14 of 15 acoustic neurinoma patients. Facial nerve function was preserved in 12 of 15 patients and preoperative hearing maintained in 5 of 15 patients.

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ABSTRACT.Fifty-seven cases of recurrent head and neck malignancies unsuitable for further X-ray or surgery were treated with cryosurgery. The cases were divided into two groups: a symptomatic group of 21 cases treated only when symptoms became severe and an asymptomatic group of 36 cases treated early in an effort to produce significant prolongation of life. In the symptomatic group, pain relief was obtained in 7 of 8 patients (86.5 percent) and symptoms related to tumor bulk were relieved in 11 of 13 patients (84.6 percent). Thirty-six asymptomatic cases treated at the time recurrence was first diagnosed, showed a definite trend of increased survival when compared with matched cases treated prior to the advent of cryosurgery.

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