Report of 190 consecutive cases of large acoustic tumors (vestibular schwannoma) removed via the translabyrinthine approach

Object. The choice of approach for surgical removal of large acoustic neuro mas is still controversial. The authors reviewed the results in a series of patients who underwent removal of large tumors via the translabyrinthine a pproach. Methods. The authors conducted a database analysis of 190 patients (89 men and 101 women) with acoustic neuromas 3 cm or greater in size. The mean age of these patients was 46.1 +/- 15.6 years. One hundred seventy-eight patie nts underwent primary translabyrinthine surgical removal and 12 underwent s urgery for residual tumor. Total tumor removal was accomplished in 183 case s (96.3%). The tumor was adherent to the facial nerve to some degree in 64% of the cases, but the facial nerve was preserved anatomically in 178 (93.7 %) of the patients. Divided nerves were repaired by primary attachment or c able graft. Facial nerve function was assessed immediately after surgery, a t the time of discharge, and at 3 to 4 weeks and 1 year after discharge. Ex cellent function (House-Brackmann facial nerve Grade I or II) was present i n 55%, 33.9%, 38.8%, and 52.6% of the patients for each time interval, resp ectively, with acceptable function (Grades I-IV) in 81% at 1 year. Cerebros pinal fluid leakage that required surgical repair occurred in only 1.1% of the patients and meningitis in 3.7%. There were no deaths. Conclusions. Use of the translabyrinthine approach for removal of large tum ors resulted in good anatomical and functional preservation of the facial n erve, with minimum incidence of morbidity and no incidence of mortality. Th e authors continue to recommend use of this approach for acoustic tumors la rger than 3 cm and for smaller tumors when hearing preservation is not an i ssue.