Introduction: Acoustic Neuroma /Vestibular Schwannoma (VS) surgery continues to be debated at all neurosurgical meetings.A wide array of issues is discussed and surgical steps are now fairly standardized.Yet there are number of controversial and contentious issues and some of the interesting statements made at these meetings by authors and audience alike are listed and our views supported by our experience over 1000 cases debated in this paper
Methods: Our study of over 1000 cases of acoustic schwannoma surgery was taken into consideration
Results: Some of controversial or strange views are:
1 Pre-op shunt when there is hydrocephalus
2 Subtotal or staged removal is better for patients
3 lift the large tumor and pass a cotton patty between its lower pole and lower cranial nerves at the outset
4 not necessary to open the internal auditory canal(IAC)
5 using a hook to deliver the portion lying laterally in the incompletely or unopened ICA
6 do not botherabout the eighth nerve
7 eighth nerve preservation responsible for intractable tinnitus
8 gamma knife preferred to microsurgery
Conclusions: Surgery for VS remains the most challenging chapter of neurosurgery. Experience in microsurgery and intraoperative monitoring have lead to very superior results with almost zero mortality and minimal morbidity which, if any , is mostly restricted to malfunction of 7th and 8th cranial nerves
Patient Care: Young neurosurgeons need to train with the masters in the field to derive the nuances of this complex surgery and there frequent encounter with large number of personally operated cases can help them emulate the results of experts and this will improve the patients care
Learning Objectives: This paper is meant to put the microsurgery of VS in the right perspective and thereby learning the nuances of the surgery