[Suboccipito-transmeatal microsurgical approach in giant acoustic neuromas. Results in 12 consecutive cases]

Since 1975, 12 patients harboring huge acoustic neurinomas were operated on by the authors. Nine of them had manifestations of intracranial hypertension with papilledema and in eight cases a facial weakness of variable degree was detected preoperatively. A ventriculo-atrial shunt was inserted in eight patients before the craniotomy. All procedures were carried out with the patient in the semisitting position, with the aid of the operating microsope and using a suboccipital-transmeatal approach. Total removal was carried out in 10 patients, and the facial nerve was anatomically preserved in eight. Two patients died in the postoperative period because pontine infarction and bilateral bronchopneumonia respectively. Those patients with preoperative facial weakness never obtained a total recovery in spite of a correct anatomical preservation. Surgical technique, operative mortality and morbidity and results are thoroughly discussed.