title: Translabyrinthine approach for the management of large and giant vestibular schwannomas.
abstract: BACKGROUND
  The removal of large vestibular schwannomas through the translabyrinthine approach is still controversial.
  
  
  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 I or II) 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Otolaryngology, Northwestern University Medical School, Evanston Hospital, Evanston Northwestern Health Care System, Evanston, Illinois 60201, USA.
authors.forename: Bulent
authors.initials: B
authors.lastname: Mamikoglu
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wiet
authors.forename: Carlos R
authors.initials: CR
authors.lastname: Esquivel
mesh_terms: D000714:Anastomosis, Surgical; D002558:Cerebrospinal Fluid Otorrhea / Q000453:epidemiology / Q000209:etiology; D007758:Ear, Inner; D005154:Facial Nerve / Q000033:anatomy & histology / Q000601:surgery; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000209:etiology; D006801:Humans; D008297:Male; D008581:Meningitis / Q000453:epidemiology / Q000209:etiology; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000150:complications / Q000601:surgery*; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology / Q000209:etiology