目的 :对巨大听神经瘤的最佳手术入路进行探讨。方法 :对36例巨大听神经瘤手术的结果进行回顾性分析研究 ,分别采用经枕下乙状窦后入路 ,枕下正中入路 ,小脑幕上幕下联合入路 ,扩大乙状窦前入路等四种手术方式。结果 :经枕下乙状窦后入路20例 ,全切除17例 ,保留面神经8例 ,保留听神经4例。经枕下正中入路10例 ,全切除4例 ,保留面神经4例 ,听神经均未能保留。经小脑幕上 ,幕下联合入路4例 ,全切除4例 ,保留面神经4例 ,保留听神经1例。经扩大乙状窦前入路2例 ,全切除2例 ,保留面神经2例 ,保留听神经1例。结论 :选择扩大乙状窦前入路是较为理想的选择 Objective: To investigate the best surgical approach for giant acoustic neuroma. Methods: The results of 36 cases of giant acoustic neuroma were retrospectively analyzed. The transtibial sigmoid sinus posterior approach, suboccipital posterior approach, and supratentorial tentorial approach were used respectively to expand the sigmoid anterior approach And other four surgical methods. Results: Twenty submandibular sigmoid sinus posterior approach, total resection in 17 cases, facial nerve preservation in 8 cases, 4 cases of reserved auditory nerve. Transient under the suboccipital approach in 10 cases, 4 cases of total resection, facial nerve preservation in 4 cases, the auditory nerve can not be retained. The tentorium, the infratentorial approach in 4 cases, 4 cases of total resection, facial nerve preservation in 4 cases, leaving the auditory nerve in 1 case. The anterior approach to the sigmoid sinus enlargement in 2 cases, 2 cases of total resection, facial nerve preservation in 2 cases, 1 case of reserved auditory nerve. Conclusion: Choosing to enlarge the sigmoid anterior approach is an ideal choice