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«Figure 1.: Cutaneous horn Senile keratosis Generally it is a flat, yellowish-brown smooth mass with indistinct borders that stands out of the ...»

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Stereotaxic radiation surgery: an aimed single large dosage radiation with linear accelerator or Co 60 gamma rays. (gamma knife) It can be used with tumours less than 2.5-3 cm, and in the case of old, high risk patients, if the patient’s other ear is deaf. Success rate: in 80 % of the cases the size of the tumour decreases or it stops growing. A further advantage is that it is an out- patients procedure, involves less stress and no surgical risk.

If due to the slow growth of the tumour it gives rise to very few complaints we can just ’wait and scan’, provided we inform the patient about possible consequences. Very close follow-up, annual MR required.

Follow up Whatever therapy has been done the yearly MR control is justified.

Acustic neuroma is a good example of the necessity of collaboration between related branches of knowledge. Because of the primary otological symptoms early diagnostics are in the hands of the ear specialist. He must think in time of having imaging tests made. The operation itself is often made by neurosurgeons, but hearing rehabilitation is again the task of the ear specialist. In the case of bilateral tumour NF 2 familial examination, and genetic advice is needed. Before deafness sets in the patient must be taught how to read lips. An instrument of hearing rehabilitation is grafting a brain stem hearing implant.

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