Small acoustic neuromas: detection by high resolution gas CT cisternography

Experience with 81 gas computed tomography (CT) cisternography procedures in 79 patients in searching for acoustic neuroma is reported. Twenty-one tumors, four exclusively intracanalicular, were demonstrated after standard contrast-enhanced CT was negative. Fifty-five examinations were negative; four were inconclusive. The high resolution scanner with digital localization and reconstruction zoom capability greatly improved image detail. In nine of the 12 normal patients examined with it, the intracanalicular bundle was demonstrated. Substitution of carbon dioxide for air greatly reduced the morbidity of acute post-spinal tap headache. The procedure takes 30--45 min and can be performed on an outpatient basis. It is recommended as the procedure of choice when standard CT is negative in subjects clinically suspected of having acoustic neuroma.