{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T09:05:50Z","timestamp":1780131950231,"version":"3.54.0"},"reference-count":70,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2012,9]]},"abstract":"<jats:p>Removal of vestibular schwannomas (VSs, or acoustic neuromas) remains one of the most challenging operations in neurosurgery. Giant or huge tumors (&gt; 5 cm) heighten these challenges, and technical nuances play a special role in maximizing tumor resection while minimizing complications. In this article, the senior author describes his technical experience with microsurgical excision of giant VSs. The accompanying video further illustrates these details.<\/jats:p>","DOI":"10.3171\/2012.7.focus12177","type":"journal-article","created":{"date-parts":[[2012,9,1]],"date-time":"2012-09-01T12:14:35Z","timestamp":1346501675000},"page":"E15","source":"Crossref","is-referenced-by-count":8,"title":["Technical nuances of resection of giant (&gt; 5 cm) vestibular schwannomas: pearls for success"],"prefix":"10.3171","volume":"33","author":[{"given":"Charles G.","family":"Kulwin","sequence":"first","affiliation":[{"name":"Goodman Campbell Brain and Spine, and Indiana University Department of Neurological Surgery, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron A.","family":"Cohen-Gadol","sequence":"additional","affiliation":[{"name":"Goodman Campbell Brain and Spine, and Indiana University Department of Neurological Surgery, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0330015","series-title":"Anesthesiology","first-page":"49","article-title":"Outcome following posterior fossa craniectomy in patients in the sitting or horizontal positions","volume":"69","author":"Black","year":"1988"},{"key":"b2-0330015","series-title":"Otolaryngol Head Neck Surg","first-page":"1020","article-title":"Management of hydrocephalus resulting from acoustic neuromas","volume":"109","author":"Briggs","year":"1993"},{"key":"b3-0330015","series-title":"Acta Otolaryngol","first-page":"1249","article-title":"Perioperative complications after translabyrinthine removal of large or giant vestibular schwannoma: outcomes for 123 patients","volume":"130","author":"Charpiot","year":"2010"},{"key":"b4-0330015","series-title":"Neurosurgery","first-page":"915","article-title":"Staged removal of acoustic tumors: techniques and lessons learned from a series of 83 patients","volume":"37","author":"Comey","year":"1995"},{"key":"b5-0330015","series-title":"Neurosurgery","first-page":"1282","article-title":"Venous air embolism in sitting and supine patients undergoing vestibular schwannoma resection","volume":"42","author":"Duke","year":"1998"},{"key":"b6-0330015","series-title":"Br J Neurosurg","first-page":"448","article-title":"The operative learning curve for vestibular schwannoma excision via the retrosigmoid approach","volume":"16","author":"Elsmore","year":"2002"},{"key":"b7-0330015","series-title":"J Neurosurg","first-page":"820","article-title":"Facial nerve function after vestibular schwannoma surgery. Clinical article","volume":"115","author":"Falcioni","year":"2011"},{"key":"b8-0330015","series-title":"J Laryngol Otol","first-page":"935","article-title":"Cystic vestibular schwannoma: surgical outcome","volume":"114","author":"Fundov\u00e1","year":"2000"},{"key":"b9-0330015","series-title":"Ann Otol Rhinol Laryngol","first-page":"55","article-title":"Hearing preservation in unilateral acoustic neuroma surgery","volume":"97","author":"Gardner","year":"1988"},{"key":"b10-0330015","series-title":"J Neurosurg","first-page":"1209","article-title":"Hydrocephalus associated with vestibular schwannomas: management options and factors predicting the outcome. Clinical article","volume":"114","author":"Gerganov","year":"2011"},{"key":"b11-0330015","series-title":"Neurosurgery","first-page":"50","article-title":"Acoustic neuromas: results of current surgical management","volume":"41","author":"Gormley","year":"1997"},{"key":"b12-0330015","series-title":"Neurosurg Clin N Am","first-page":"199","article-title":"Acoustic neuroma","volume":"1","author":"Jackler","year":"1990"},{"key":"b13-0330015","series-title":"Neurosurg Clin N Am","first-page":"217","article-title":"Selection of surgical approach to acoustic neuroma. 1992","volume":"19","author":"Jackler","year":"2008"},{"key":"b14-0330015","series-title":"Otol Neurotol","first-page":"224","article-title":"Translabyrinthine approach for the management of large and giant vestibular schwannomas","volume":"23","author":"Mamikoglu","year":"2002"},{"key":"b15-0330015","series-title":"World Neurosurg","article-title":"Surgery for giant acoustic neuroma: total excision at what cost","author":"Misra","year":"2011"},{"key":"b16-0330015","series-title":"J Neurooncol","first-page":"167","article-title":"Therapeutic strategy for large vestibular schwannomas","volume":"77","author":"Park","year":"2006"},{"key":"b17-0330015","series-title":"Otolaryngol Head Neck Surg","first-page":"11","article-title":"Staged resection of large acoustic neuromas","volume":"132","author":"Patni","year":"2005"},{"key":"b18-0330015","series-title":"Neurosurgery","first-page":"1246","article-title":"Management of hydrocephalus associated with vestibular schwannoma and other cerebellopontine angle tumors","volume":"48","author":"Pirouzmand","year":"2001"},{"key":"b19-0330015","series-title":"J Neurosurg","first-page":"1126","article-title":"Staged resection of large vestibular schwannomas. Clinical article","volume":"116","author":"Raslan","year":"2012"},{"key":"b20-0330015","series-title":"J Clin Neurosci","first-page":"520","article-title":"Complications related to positioning in posterior fossa craniectomy","volume":"14","author":"Rath","year":"2007"},{"key":"b21-0330015","series-title":"Otol Neurotol","first-page":"826","article-title":"A model for early prediction of facial nerve recovery after vestibular schwannoma surgery","volume":"32","author":"Rivas","year":"2011"},{"key":"b22-0330015","series-title":"Prog Neurol Surg","first-page":"214","article-title":"Vestibular schwannomas: complications of microsurgery","volume":"21","author":"Roche","year":"2008"},{"key":"b23-0330015","series-title":"Acta Neurochir (Wien)","first-page":"1359","article-title":"The first 50s: can we achieve acceptable results in vestibular schwannoma surgery from the beginning?","volume":"152","author":"Roser","year":"2010"},{"key":"b24-0330015","series-title":"J Neurosurg","first-page":"527","article-title":"Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients","volume":"105","author":"Samii","year":"2006"},{"key":"b25-0330015","series-title":"J Neurosurg","first-page":"860","article-title":"Functional outcome after complete surgical removal of giant vestibular schwannomas. Clinical article","volume":"112","author":"Samii","year":"2010"},{"key":"b26-0330015","series-title":"Neurosurgery","first-page":"11","article-title":"Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them","volume":"40","author":"Samii","year":"1997"},{"key":"b27-0330015","series-title":"J Neurosurg","first-page":"70","article-title":"Microanatomical variations in the cerebellopontine angle associated with vestibular schwannomas (acoustic neuromas): a retrospective study of 1006 consecutive cases","volume":"92","author":"Sampath","year":"2000"},{"key":"b28-0330015","series-title":"Otol Neurotol","first-page":"379","article-title":"Perioperative complications in acoustic neuroma (vestibular schwannoma) surgery","volume":"25","author":"Sanna","year":"2004"},{"key":"b29-0330015","series-title":"J Neurosurg","first-page":"37","article-title":"The two-stage excision of huge acoustic neurinomas","volume":"51","author":"Sheptak","year":"1979"},{"key":"b30-0330015","series-title":"World Neurosurg","article-title":"Surgical removal of giant acoustic neuromas","author":"Silva","year":"2011"},{"key":"b31-0330015","series-title":"Otolaryngol Head Neck Surg","first-page":"726","article-title":"Acoustic neuroma surgical cost and outcome by hospital volume in California","volume":"130","author":"Slattery","year":"2004"},{"key":"b32-0330015","series-title":"Clin Radiol","first-page":"357","article-title":"The role of radiology in the diagnosis and management of vestibular schwannoma","volume":"66","author":"Sriskandan","year":"2011"},{"key":"b33-0330015","series-title":"J Neurosurg","first-page":"747","article-title":"Technical and instrumental improvements in the surgical treatment of acoustic neurinomas","volume":"57","author":"Sugita","year":"1982"},{"key":"b34-0330015","series-title":"J Neurosurg","first-page":"1188","article-title":"Clinical and neuroimaging characteristics of hydrocephalus associated with vestibular schwannoma","volume":"98","author":"Tanaka","year":"2003"},{"key":"b35-0330015","series-title":"Otol Neurotol","first-page":"460","article-title":"Is it worthwhile to attempt hearing preservation in larger acoustic neuromas?","volume":"24","author":"Yates","year":"2003"},{"key":"b1-0330015","series-title":"Anesthesiology","first-page":"49","article-title":"Outcome following posterior fossa craniectomy in patients in the sitting or horizontal positions","volume":"69","author":"Black","year":"1988"},{"key":"b2-0330015","series-title":"Otolaryngol Head Neck Surg","first-page":"1020","article-title":"Management of hydrocephalus resulting from acoustic neuromas","volume":"109","author":"Briggs","year":"1993"},{"key":"b3-0330015","series-title":"Acta Otolaryngol","first-page":"1249","article-title":"Perioperative complications after translabyrinthine removal of large or giant vestibular schwannoma: outcomes for 123 patients","volume":"130","author":"Charpiot","year":"2010"},{"key":"b4-0330015","series-title":"Neurosurgery","first-page":"915","article-title":"Staged removal of acoustic tumors: techniques and lessons learned from a series of 83 patients","volume":"37","author":"Comey","year":"1995"},{"key":"b5-0330015","series-title":"Neurosurgery","first-page":"1282","article-title":"Venous air embolism in sitting and supine patients undergoing vestibular schwannoma resection","volume":"42","author":"Duke","year":"1998"},{"key":"b6-0330015","series-title":"Br J Neurosurg","first-page":"448","article-title":"The operative learning curve for vestibular schwannoma excision via the retrosigmoid approach","volume":"16","author":"Elsmore","year":"2002"},{"key":"b7-0330015","series-title":"J Neurosurg","first-page":"820","article-title":"Facial nerve function after vestibular schwannoma surgery. Clinical article","volume":"115","author":"Falcioni","year":"2011"},{"key":"b8-0330015","series-title":"J Laryngol Otol","first-page":"935","article-title":"Cystic vestibular schwannoma: surgical outcome","volume":"114","author":"Fundov\u00e1","year":"2000"},{"key":"b9-0330015","series-title":"Ann Otol Rhinol Laryngol","first-page":"55","article-title":"Hearing preservation in unilateral acoustic neuroma surgery","volume":"97","author":"Gardner","year":"1988"},{"key":"b10-0330015","series-title":"J Neurosurg","first-page":"1209","article-title":"Hydrocephalus associated with vestibular schwannomas: management options and factors predicting the outcome. Clinical article","volume":"114","author":"Gerganov","year":"2011"},{"key":"b11-0330015","series-title":"Neurosurgery","first-page":"50","article-title":"Acoustic neuromas: results of current surgical management","volume":"41","author":"Gormley","year":"1997"},{"key":"b12-0330015","series-title":"Neurosurg Clin N Am","first-page":"199","article-title":"Acoustic neuroma","volume":"1","author":"Jackler","year":"1990"},{"key":"b13-0330015","series-title":"Neurosurg Clin N Am","first-page":"217","article-title":"Selection of surgical approach to acoustic neuroma. 1992","volume":"19","author":"Jackler","year":"2008"},{"key":"b14-0330015","series-title":"Otol Neurotol","first-page":"224","article-title":"Translabyrinthine approach for the management of large and giant vestibular schwannomas","volume":"23","author":"Mamikoglu","year":"2002"},{"key":"b15-0330015","series-title":"World Neurosurg","article-title":"Surgery for giant acoustic neuroma: total excision at what cost","author":"Misra","year":"2011"},{"key":"b16-0330015","series-title":"J Neurooncol","first-page":"167","article-title":"Therapeutic strategy for large vestibular schwannomas","volume":"77","author":"Park","year":"2006"},{"key":"b17-0330015","series-title":"Otolaryngol Head Neck Surg","first-page":"11","article-title":"Staged resection of large acoustic neuromas","volume":"132","author":"Patni","year":"2005"},{"key":"b18-0330015","series-title":"Neurosurgery","first-page":"1246","article-title":"Management of hydrocephalus associated with vestibular schwannoma and other cerebellopontine angle tumors","volume":"48","author":"Pirouzmand","year":"2001"},{"key":"b19-0330015","series-title":"J Neurosurg","first-page":"1126","article-title":"Staged resection of large vestibular schwannomas. Clinical article","volume":"116","author":"Raslan","year":"2012"},{"key":"b20-0330015","series-title":"J Clin Neurosci","first-page":"520","article-title":"Complications related to positioning in posterior fossa craniectomy","volume":"14","author":"Rath","year":"2007"},{"key":"b21-0330015","series-title":"Otol Neurotol","first-page":"826","article-title":"A model for early prediction of facial nerve recovery after vestibular schwannoma surgery","volume":"32","author":"Rivas","year":"2011"},{"key":"b22-0330015","series-title":"Prog Neurol Surg","first-page":"214","article-title":"Vestibular schwannomas: complications of microsurgery","volume":"21","author":"Roche","year":"2008"},{"key":"b23-0330015","series-title":"Acta Neurochir (Wien)","first-page":"1359","article-title":"The first 50s: can we achieve acceptable results in vestibular schwannoma surgery from the beginning?","volume":"152","author":"Roser","year":"2010"},{"key":"b24-0330015","series-title":"J Neurosurg","first-page":"527","article-title":"Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients","volume":"105","author":"Samii","year":"2006"},{"key":"b25-0330015","series-title":"J Neurosurg","first-page":"860","article-title":"Functional outcome after complete surgical removal of giant vestibular schwannomas. Clinical article","volume":"112","author":"Samii","year":"2010"},{"key":"b26-0330015","series-title":"Neurosurgery","first-page":"11","article-title":"Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them","volume":"40","author":"Samii","year":"1997"},{"key":"b27-0330015","series-title":"J Neurosurg","first-page":"70","article-title":"Microanatomical variations in the cerebellopontine angle associated with vestibular schwannomas (acoustic neuromas): a retrospective study of 1006 consecutive cases","volume":"92","author":"Sampath","year":"2000"},{"key":"b28-0330015","series-title":"Otol Neurotol","first-page":"379","article-title":"Perioperative complications in acoustic neuroma (vestibular schwannoma) surgery","volume":"25","author":"Sanna","year":"2004"},{"key":"b29-0330015","series-title":"J Neurosurg","first-page":"37","article-title":"The two-stage excision of huge acoustic neurinomas","volume":"51","author":"Sheptak","year":"1979"},{"key":"b30-0330015","series-title":"World Neurosurg","article-title":"Surgical removal of giant acoustic neuromas","author":"Silva","year":"2011"},{"key":"b31-0330015","series-title":"Otolaryngol Head Neck Surg","first-page":"726","article-title":"Acoustic neuroma surgical cost and outcome by hospital volume in California","volume":"130","author":"Slattery","year":"2004"},{"key":"b32-0330015","series-title":"Clin Radiol","first-page":"357","article-title":"The role of radiology in the diagnosis and management of vestibular schwannoma","volume":"66","author":"Sriskandan","year":"2011"},{"key":"b33-0330015","series-title":"J Neurosurg","first-page":"747","article-title":"Technical and instrumental improvements in the surgical treatment of acoustic neurinomas","volume":"57","author":"Sugita","year":"1982"},{"key":"b34-0330015","series-title":"J Neurosurg","first-page":"1188","article-title":"Clinical and neuroimaging characteristics of hydrocephalus associated with vestibular schwannoma","volume":"98","author":"Tanaka","year":"2003"},{"key":"b35-0330015","series-title":"Otol Neurotol","first-page":"460","article-title":"Is it worthwhile to attempt hearing preservation in larger acoustic neuromas?","volume":"24","author":"Yates","year":"2003"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/33\/3\/article-pE15.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/33\/3\/article-pE15.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/33\/3\/article-pE15.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T08:45:52Z","timestamp":1780130752000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/33\/3\/article-pE15.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,9]]},"references-count":70,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2012.7.focus12177","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,9]]}}}