title: Surgical results and technical refinements in translabyrinthine excision of vestibular schwannomas: the Gruppo Otologico experience.
abstract: BACKGROUND
  Vestibular schwannomas (VSs) are the most common cerebellopontine angle tumors, accounting for 75% of all lesions in this location.
  
  
  OBJECTIVE
  To evaluate the results after removal of VS through the enlarged translabyrinthine approach, which is a widening of the classic translabyrinthine approach that gives larger access and provides more room to facilitate tumor removal and to minimize surgery-related morbidities.
  
  
  METHODS
  This was a retrospective study of 1865 patients who underwent VS excision through the enlarged translabyrinthine approach between 1987 and 2009. Mean age was 50.39 years. Mean tumor size was 1.8 cm. Median follow-up was 5.7 years.
  
  
  RESULTS
  Total removal was achieved in 92.33% of cases; 143 patients had incomplete resection with evidence of regrowth in 8. In the 1742 previously untreated patients, anatomic preservation of facial nerve was achieved in 1661 cases (95.35%), and House-Brackmann grade I or II was reached in 1047 patients (59.87%). Facial nerve outcome was significantly better in tumors ≤ 20 mm. Surgical complications included cerebrospinal fluid leakage in 0.85%, meningitis in 0.10%, intracranial bleeding in 0.80%, non--VII/VIII cranial nerve palsy in 0.96%, cerebellar ataxia in 0.69%, and death in 0.10%. The technical modifications that evolved with increasing experience are described.
  
  
  CONCLUSIONS
  The enlarged translabyrinthine approach is a safe and effective approach for the removal of VS. In our experience, the complication rate is very low and tumor size is still the main factor influencing postoperative facial nerve function with a cutoff point at around 20 mm.
authors.affiliation: Department of Neurosurgery, Military Hospital of Tunis, University of Tunis El Manar, Tunis, Tunisia. Mehdi_ben_ammar@hotmail.com
authors.forename: Mehdi
authors.initials: M
authors.lastname: Ben Ammar
authors.forename: Enrico
authors.initials: E
authors.lastname: Piccirillo
authors.forename: Vedat
authors.initials: V
authors.lastname: Topsakal
authors.forename: Abdelkader
authors.initials: A
authors.lastname: Taibah
authors.forename: Mario
authors.initials: M
authors.lastname: Sanna
mesh_terms: D007758:Ear, Inner / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000473:pathology / Q000601:surgery*; D013506:Otologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome