Enlarged translabyrinthine approach for the management of large and giant acoustic neuromas: a report of 175 consecutive cases.

The translabyrinthine approach was once considered inadequate for the removal of acoustic neuromas (ANs), but that theory has few proponents today. Over the years, the translabyrinthine approach has been modified into the enlarged translabyrinthine approach, with experience and technical refinements leading to a wider access. Between April 1987 and December 2001, the Gruppo Otologico of Piacenza-Rome was able to remove 175 ANs 3 cm or larger in size from the cerebellopontine angle by adopting this modified surgical technique. These tumors represented 24.7% of all 707 ANs for which surgery was performed during the same period of time. Among the 175 cases, there was only 1 death. The incidence of complications was very low and was comparable to results previously published in the literature. Consequently, the hospital stay was short, with a mean of 7.3 days (5.1 days in the last 45 cases). The preoperative ipsilateral hearing was already compromised in 119 of the 175 cases (68%; class C/D according to the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery, 1995). From our results, we can conclude that the use of the enlarged translabyrinthine approach in AN surgery is not dependent on tumor size. On the contrary, the advantages of a low rate of morbidity and a short hospital stay are ample proof that this is the best approach for the removal of large ANs.