Clinical Analysis of small Acoustic neuromas With Initial Neurological Symptoms

Abstract Background Initial neurological manifestations involved with Acoustic neuromas (ANs) are easily misdiagnosed due to nonspecific symptoms. The objective is to investigate and describe the clinical features of small ANs presenting with initial neurological manifestations, to allow earlier diagnosis and more well-timed interference for patients with this disease. Methods This was a retrospective cross-sectional study that included 22 patients. The detailed clinical information with initial symptoms of neurological manifestations caused by small ANs between January 2010 and May 2020 were retrospectively analyzed. The collected data included symptoms, signs, neuroimaging results, and pathologic diagnoses. Results There were 9 males and 13 females, and their ages ranged from 22 to 74 years. Dizziness/vertigo was the most common initial presenting symptom in 9 of the 22 patients. Headache was the second most frequent initial presenting symptom in 8 of 22. Neuro-physical examination found that the facial nerve and auditory nerve were the most involved cranial nerves, with remaining positive signs involving abnormalities of the optic nerve, trigeminal nerve and abducens nerve as well as ataxia and nystagmus. More than half of the patients underwent microsurgery and had postoperative clinical symptom improvement. The patients who chose the observation method showed no change in tumor size at follow-up. Conclusions Dizziness/vertigo and headache are the most common initial neurological symptoms of small ANs and should be considered in the differential diagnosis of patients. The results suggest that MRI is the best tool in diagnosis for small ANs. Observation and microsurgery are safe and common methods for the treatment.