Enlarged translabyrinthine approach with transapical extension in the management of giant vestibular schwannomas: personal experience and review of literature.

OBJECTIVE: To describe and analyze the main outcomes achieved in a series of patients with sporadic vestibular schwannoma (VS) larger than 40 mm in extrameatal diameter, defined as giant VS, submitted to microsurgery by the enlarged translabyrinthine approach with transapical extension. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: A retrospective chart review was conducted on 2,133 patients who underwent surgery for VS from April 1987 to July 2009. One hundred ten cases of giant VS were elected for analysis. MAIN OUTCOME MEASURES: Extent of removal, residual or recurrent disease, facial nerve integrity during surgery, long-term facial nerve function, and postoperative complications. RESULTS: Total removal was accomplished in 91.8% of cases. In 5 patients (4.5%), total removal was accomplished in 2 stages. Near-total removal was performed in 7 patients (6.3%). The facial nerve was anatomically preserved in 76.4% of cases. Intraoperative facial nerve reconstruction was performed in 8 cases. Facial nerve function after 1 year of follow-up was House-Brackmann grades I to III in 75% of cases. There were no deaths in this series. Neurovascular life-threatening complications occurred in 2 patients. Cerebrospinal fluid leak was present in 1.8% of cases. CONCLUSION: Results indicate the enlarged translabyrinthine approach with transapical extension as an elective approach for removal of giant VS. The method permits achievement of a high rate of total removal with low incidence of complications.