title: [Treatment of giant acoustic neuromas].
abstract: OBJECTIVE
  To analyze the treatment modality and outcome of a series of patients with giant acoustic neuromas, a particular type of tumour characterised by their size (extracanalicular diameter of 4cm or more) and high morbidity and mortality.
  
  
  METHODS
  This was a retrospective unicentre study of patients with acoustic neuromas treated in a period of 12 years. In our institutional series of 108 acoustic neuromas operated on during that period, we found 13 (12%) cases of giant acoustic neuromas. We reviewed the available data of these cases, including presentation and several clinical, anatomical, and microsurgical aspects.
  
  
  RESULTS
  All patients were operated on by the same neurosurgeon and senior author (EU) using the suboccipital retrosigmoid approach and complete microsurgical removal was achieved in 10 cases. In one case, near total removal was deliberately performed, in another case a CSF shunt was placed as the sole treatment measure, and in the remaining case no direct treatment was given. One patient died in the immediate postoperative period. One year after surgery, 4 patients showed facial nerve function of iii or more in the House-Brackman scale.
  
  
  CONCLUSIONS
  The 4 most important prognostic characteristics of giant acoustic neuromas are size, adhesion to surrounding structures, consistency and vascularity. Only the first of these is evident in neuroimaging. Giant acoustic neuromas are characterised by high morbidity at presentation as well as after treatment. Nevertheless, the objective of complete microsurgical removal with preservation of cranial nerve function is attainable in some cases through the suboccipital retrosigmoid approach.
authors.affiliation: Servicio de Neurocirugía, Hospital Universitario Donostia, San Sebastián, España. Electronic address: nicolas.sampron@me.com.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Samprón
authors.affiliation: Servicio de Otorrinolaringología, Hospital Universitario Donostia, San Sebastián, España.
authors.forename: Xabier
authors.initials: X
authors.lastname: Altuna
authors.affiliation: Servicio de Neurocirugía, Hospital Universitario Donostia, San Sebastián, España.
authors.forename: Mikel
authors.initials: M
authors.lastname: Armendáriz
authors.affiliation: Servicio de Neurocirugía, Hospital Universitario Donostia, San Sebastián, España.
authors.forename: Enrique
authors.initials: E
authors.lastname: Urculo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000473:pathology / Q000601:surgery*; D019635:Neurosurgical Procedures; D012189:Retrospective Studies
keywords: Acoustic neuroma; Facial nerve; Functional outcome; Hearing loss; Hipoacusia; Microcirugía; Microsurgery; Nervio facial; Neurinoma acústico; Resultado funcional; Schwannoma vestibular; Vestibular schwannoma