OBJECTIVETo analyze the surgical outcomes and share experience in the surgical management of acoustic neuroma(AN).

METHODSA retrospective review was performed in 134 patients with sporadic large ANs operated from Jan. 2001 to Dec. 2012. The patients' information, tumor size, tumor cystic degeneration, surgical approach, intraoperative anatomical facial nerve integrity rate, postoperative facial nerve function and complications were recorded.

RESULTSThere were one hundred and twenty-nine patients (96.3%) received surgeries within one month after first diagnosis of vestibular schwannoma(VS) or definite diagnosis of recurrence.Five patients (3.7%) hesitated to be operated until tumor was found to be growing on MRI during the follow-up. The average tumor diameter was about (40.9 ± 6.8) mm (31.0-70.0 mm). The cystic tumor percentage arrived at 35.1% (47/134). The surgical approaches included 118(88.1%) translabyrinthine approaches, comprising 16(11.9%) modified enlarged translabyrinthine approaches, and 16 (11.9%) transaortic approaches. Total, near total, and subtotal tumor removal rate was 91.0% (122/134), 6.7% (9/134) and 2.2% (3/134), respectively. The anatomical facial nerve integrity was preserved in 88.8% (19/134) of all patients. And it was significantly lower in cystic VS (80.9% vs 93.1%, P = 0.044). There were 32.3% (43/133) and 36.8% (49/133) of patients had a good postoperative facial nerve function in short-term (discharge from hospital) and long-term (1 year) follow-up, respectively.General rate of complications was 17.9% (24/134). CSF leakage occurred in 7.5% of patients. Mortality rate was 0.7% (1/134). Follow-up time ranged from 1 to 5 years, average time was(2.7 ± 0.4)years.Four cases occurred recurrence.

CONCLUSIONSMajor management strategy of large AN is surgical resection.Even for those who had temporary antagonism for surgery, the wait and scan policy is necessary. Although the tumor removal is safe and accompanies extremely low mortality and incidence of complication, the patient with large AN must be informed in detail about the possible surgical risks. The tumor cystic degeneration is an important crucial factor which influences the surgical outcomes of AN, especially in postoperative facial nerve function.