Surgical treatment of large vestibular schwannomas (stages III and IV).

OBJECTIVE Study the results of surgical treatment of large vestibular schwannomas. MATERIAL AND METHODS Between January 1995 and December 2005, 87 stage III and IV unilateral vestibular schwannomas (Koos classification) were operated. RESULTS The approach used was for the most part translabyrinthine. Nine patients were operated in two phases. Tumor exeresis was total in 79% of the cases, nearly total in 17%, and subtotal in 3.6%. Good facial function was preserved in 63% of the patients. Mortality was zero. Tumor control after a mean follow-up of 45 months was 86%. CONCLUSIONS Surgery for large vestibular schwannomas should have a 0% mortality rate and low morbidity. Otoneurosurgical collaboration, with a preference for the translabyrinthine approach, with surgery undertaken in several phases if need be, provides maximum safety and good functional results as well as an acceptable residual tumor rate.