Management of Acoustic Neuroma

To the Editor: Kondziolka et al. in their study (Nov. 12 issue) 1 and Pitts and Jackler in their accompanying editorial 2 miss two important issues concerning radiosurgery for acoustic neuromas. First, since the age of the patient is relevant to the decision about treatment, a more detailed analysis of age is required. We and a number of others recommend observation, not surgery, for patients over the age of 65 years with acoustic neuromas that are not causing distortion of the brain stem. Imaging is repeated as necessary, depending on the size of the tumor, and most of these older patients never . . .