The treatment of giant acoustic neuromas

It is widely accepted that giant acoustic tumors (4 cm or more in diameter) require surgical treatment. However, this is a demanding technical procedure, with possible postoperative neurological dysfunction and complications. Giant tumors are frequent in specialized centers, representing about 15% of the total number of acoustic neuromas. The size of the tumor is an important factor concerning the difficulties of surgery. Learning is time-consuming, and the results are highly dependent on surgeon’s skill and on a well trained team. The details of the procedure are briefly explained, given attention to the more important steps and possible pitfalls. In my personal view, total removal of the tumor in a single operation should be the goal of the surgery. Since experience is crucial, I defend the referral between Neurosurgery departments. The importance of anatomical training and the role of excellent intraoperative monitoring is emphasized. Excellent intraoperative monitoring and postoperative management in a Neurocritical Care Unit are important factors for a good outcome. For conclusion, with adequate training and experience, total removal of the tumor in a single operation is possible, with acceptable rates of morbidity and no mortality.