[Translabyrinthine--transtentorial approach for removal of large acoustic neuromas]

In 30 consecutive patients with large acoustic neuromas, which were more than 4.0 cm in diameter, tumor excision was performed by a one-stage combined translabyrinthine-transtentorial approach. The tumors were totally removed in 29 patients (96.7%), without death. The facial nerve was preserved anatomically in 16 patients (53.3%), and functionally in 11 (36.7%). Main advantages of this approach include: (1) direct approach with a more extensive exposure; (2) identification of both the origin of the facial nerve at the brain stem or in the internal auditory canal: (3) minimal postoperative reaction; (4) combination with other approaches. A brief discussion is been made on operative technique, prevention of postoperative complications and facial nerve preservation.