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For such a relatively rare tumour, acoustic neuroma continues to hold a remarkable fascination for both neurosurgeons and neuro-otologists. The Third International Conference on Acoustic Neuroma in Rome last June continued for 5 days!
The early controversies in the management of acoustic neuromas were largely about the surgical approaches which might be used and about the outcome of facial nerve function. In this period the improved outcomes which could be achieved by utilising the combined expertise of otologists and neurosurgeons, were clearly demonstrated. Likewise, the advantages to be gained by monitoring facial nerve function were also firmly established. More recently, controversy has shifted to the question of hearing preservation and, in particular, to the unresolved problem of what constitutes “useful” hearing. The place of intraoperative brain stem auditory evoked response (BAER) audiometry in improving hearing outcomes is still uncertain, largely because of the known difficulties in obtaining reliable recordings. However, on empirical grounds it is likely that if hearing preservation rates are to improve, BAER audiometry will play a significant part in this improvement. The paper1 by Tonn et al in this issue (pp 161–166) once more emphasises the benefits of …