title: Surgical removal of giant acoustic neuromas.
abstract: OBJECTIVE
  The authors present the outcome of radical surgical removal of giant acoustic neuromas.
  
  
  METHODS
  Twenty-nine patients with acoustic neuroma with maximum diameter greater than 40 mm, submitted to surgery between the years 2005 and 2010, were reviewed by a retrospective study. The extension of tumor removal, surgical morbidity, facial nerve function, hearing, and evolution after surgery of preoperative neurologic conditions were the studied parameters.
  
  
  RESULTS
  All tumors were completely removed by a retrosigmoid approach, without perioperative mortality. As complications related to the surgery, there were three cases of local cerebrospinal fluid leak, one case of nasal cerebrospinal fluid leak, two cases of meningitis, one pseudomeningocele, and one case of transient lower cranial nerve dysfunction. The anatomic integrity of the facial nerve was preserved in 86% and facial function in 72%. In the 21 patients who did not need hypoglossal-facial anastomosis (72%), facial function was excellent or good (HB I-II) in 13 cases (45%), fair (HB III) in 5 cases (17%), and poor (HB IV) in 3 cases (10%). Before surgery, 12 patients (41%) had useful (H2) or moderate (H3) hearing. In 7 of these 12 patients (58%), it was possible to preserve some hearing function (with moderate hearing), after surgical removal of the tumors. Six patients presented with radiologic signs of hydrocephalus, two of them with visual disturbances. Two patients presented with trigeminal neuralgia (one contralateral), three with facial sensory loss and one with swallowing problems, that disappeared after surgery.
  
  
  CONCLUSIONS
  Total removal of large acoustic neuroma can be achieved by retrosigmoid approach with acceptable morbidity and no mortality. Preoperative neurologic symptoms recovered after surgery in most cases. Facial function preservation was possible in the majority of cases. Even in large tumors, hearing preservation should be attempted if the patient has useful hearing preoperatively.
authors: Department of Neurosurgery, Hospital São João, University of Porto, Porto, Portugal. joana.msilva@ymail.com
authors: Joana
authors: J
authors: Silva
authors: António
authors: A
authors: Cerejo
authors: Filipe
authors: F
authors: Duarte
authors: Fernando
authors: F
authors: Silveira
authors: Rui
authors: R
authors: Vaz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005145:Face; D005154:Facial Nerve / Q000502:physiology; D005155:Facial Nerve Diseases / Q000150:complications; D005260:Female; D006309:Hearing / Q000502:physiology; D006311:Hearing Disorders / Q000209:etiology; D006801:Humans; D006849:Hydrocephalus / Q000150:complications; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D009460:Neurologic Examination; D009464:Neuroma, Acoustic / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult