After 15 years of being involved in the surgical removal of acoustic tumors, otologists are still faced with the general opinion that large tumors are only managed by neurosurgeons. With improvement in surgical technique and the advancement of neurosurgery, large tumors can be successfully removed by the translabyrinthine or a combined approach.
The purpose of this paper is to define how tumor size is determined, the diagnostic problems of large tumors, and the technical aspects of their surgical removal. There are many advantages to the combined translabyrinthine-suboccipital procedure when employed by an otologist-neurosurgeon team. Morbidity and mortality rates are lowered considerably by this method.