Translabyrinthine approach for the management of large and giant vestibular schwannomas

Background: The removal of large vestibular schwannomas through the trans labyrinthine approach is still controversial. Materials and Methods: A retrospective review was performed of 81 patients (58 men and 23 women) with vestibular schwannomas 3 cm or greater, who underwent tumor removal via the translabyrinthine approach between 1985 and 2000. The mean tumor size was 3.7 +/- 0.81 cm, and the mean age of the patients was 47 +/- 16.1 years. The largest tumor was 6 cm. All surgical procedures were performed in collaboration with a neurosurgery team. Results: Total tumor removal was accomplished in 77 cases (95.1%). The facial nerve was preserved anatomically in 69 (85.2%) of the patients. In 4 patients, divided nerves were repaired by primary anastomosis. Facial nerve function was assessed immediately after surgery and 1 year or more after discharge. Good function (House-Brackmann facial nerve Grade 1 or 11) was present in 45% of patients and acceptable function (Grades I-IV) in 80% of patients 1 year after resection of the tumor. Cerebrospinal fluid leakage occurred in 12 patients (17%), meningitis developed in 3 patients (4%), and 1 patient experienced a stroke immediately after surgery. There were no deaths caused by surgery in this series. Conclusion: The translabyrinthine approach offers an excellent anatomical view of the cerebellopontine angle and a direct approach to the tumor with functional preservation of the facial nerve. Total removal is accomplished in most cases, with minimum incidence of morbidity and no incidence of mortality.