Analysis of the results obtained in 120 patients with large acoustic neuromas surgically treated via the translabyrinthine-transtentorial approach

Object. The authors review the results of a series of 120 acoustic neuromas that were surgically treated via the translabyrinthine-transtentorial approach between 1986 and 1999. Methods. The authors retrospectively evaluated a series of 120 acoustic neuromas with extrameatal diameters of 2 cm or greater, 99 (82.5%) of which had diameters longer than 3 cm. Complete tumor removal, as ascertained using computerized tomography or magnetic resonance imaging, was achieved in 110 patients (91.7%). The facial nerve was anatomically preserved in 97 patients (80.8%). The main postoperative complications were cerebrospinal fluid (CSF) leakage through the scalp wound (13.3%) requiring surgical revision in 2.5%, meningitis (9.2%), CSF rhinorrhea (6.7%) requiring surgical revision in 2.5%, and epileptic seizures (the only permanent complication) requiring medication (3.3%). There was no death directly related to the surgery. Long-term follow-up examination of the facial nerve revealed recovery of function to the level of House-Brackmann Grade I or II in 56.2% of the patients. Conclusions. The results and complications presented in this series an comparable to those reported in the literature. The authors conclude that the combined transrabyrinthine-transtentorial approach is a safe route for removing acoustic neuromas with a diameter of 2 cm or greater.