s1042368008000168.pdf

Neurosurg Clin N Am 19 (2008) xi–xii

Preface

Andrew T. Parsa, MD, PhD

Guest Editor

The treatment of vestibular schwannoma is

optimally a collaborative eﬀort between neuro-

surgeons and otolaryngologists. A multidisciplin-

ary approach is beneﬁcial to the outcome of

management decisions that can range from serial

observations to surgical intervention. The advent

of more precise radiosurgery, with lower marginal

dosing, has ushered in a new era of treatment

paradigm.

This issue presents classic articles on treatment

for acoustic neuroma patients. The revelation in

these articles is that, as state-of-the-art of scientiﬁc

and clinical aspects of acoustic neuroma continue

to advance, the concepts of basic knowledge and

expert skill presented by our predecessors remain

central to the treatment of this disease.

Presentations of William House and Clough

Shelton’s middle fossa approach, Neal Cohen’s

retrosigmoid approach, Dale Brown and Ugo

Fisch’s transotic approach are as relevant and

useful to surgeons in 2008 as they were when

discussed a decade ago. Conservative manage-

ment of acoustic neuroma continues to develop

and is discussed here by Julian Nedzelski, David

Schessel, Andrew Pﬂeiderer, Edward Kassel, and

David Rowed. The cochlear and brainstem pre-

sentation has been updated with current concepts

by Elizabeth Toh and William Luxford. Selection

of surgical approach continues to be the crucial to

the outcome for the patient and is presented in

this issue with a timeless discussion by Robert

Jackler and Lawrence Pitts. More recent discus-

sions on surgical approaches and complications,

radiosurgery and radiotherapy, and stereotactic

radiation techniques are presented by our col-

leagues in otolaryngology, Marc Bennett and

David Haynes, Ilya Likhterov, Robert Allbright

and Samuel Selesnick, and Steven Abram, Paul

Rosenblatt, and Stephen Holcomb, respectively.

Absolutely essential information on microsurgical

anatomy, imaging, nerve monitoring, and guiding

patients through surgery are presented by Albert

Rhoton and Helder Tedeschi, Hugh Curtin and

William Hirsch, Charles Yingling and John

Gardi, and Douglas Backous and Huong Pham,

respectively. Through the words of these masters,

each of us is reminded of the depth and breadth of

their work, which continues to spur us on to

advance our skills and techniques and continue to

collaborate with each other. Collectively, we strive

to continually improve functional outcomes for

our patients with acoustic neuroma.

What does the future hold? The concept

that ‘‘the treatment of patients should be

doi:10.1016/j.nec.2008.04.001

neurosurgery.theclinics.com

xii

PREFACE

dictated by tumor biology’’ is a fundamental

tenet of oncology. However, we have yet to

embrace this completely in the realm of acoustic

neuroma. For example, patients who present

with small tumors or with minimal symptoms

are often treated empirically with surgery or

radiation as a pre-emptive measure, to prevent

growth and improve long-term function. Ongo-

ing studies into molecular attributes of tumors

that correlate with growth rate, or response to

radiation, should yield important insights into

what may be most appropriate for a particular

patient.

Once we gain insights into novel treatment

paradigms that better tailor our management,

how will we disseminate this information to

patients and providers? As with many diseases,

patient advocacy has played a critical role in this

regard. In particular, the Acoustic Neuroma

Association (ANA) serves as a model patient

advocacy group that has provided important

information for 25 years to its members.

The activities of the ANA include the

following:

1) The newsletter NOTES is published quar-

terly. ANA is committed to keeping its members

informed with professionally authored medical in-

formation, self-help aids, personal accounts from

acoustic neuroma patients, and support group

updates.

2) Patient booklets deal with all aspects of

acoustic neuroma. Single copies are free to mem-

bers; larger quantities may be purchased.

3) A national symposium is presented every

other year for acoustic neuroma patients, family

members, and health care professionals.

4) Local support groups provide opportunities

for patients to communicate and network with

others.

5) Research results are produced and pub-

lished on the eﬀects of acoustic neuroma.

6) The Web site ( www.ANAUSA.org )s

maintained with an interactive ANA discussion

forum extending the goals of making information

and networking opportunities available to

patients.

The informed practitioner should be aware of

the landmark contributions in the ﬁeld, stay up-

to-date on future directions for therapy, and be

able to refer patients to resources that facilitate

a better understanding of both.

Andrew T. Parsa, MD, PhD

Department of Neurological Surgery

Neurospinal Research Center and The Brain Tumor

Research Center

University of California San Francisco

505 Parnassus Avenue; M-779

San Francisco, CA 94143, USA

E-mail address: parsaa@neurosurg.ucsf.edu

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