The continuing challenge of acoustic neurinomas (1949-1993).

Experience gained in the treatment of acoustic neurinomas over a period of 43 years is presented. This is divided into three eras based on the prevailing knowledge and techniques. Advances in diagnosis, anaesthesia and microsurgical techniques have reduced the mortality to 4% in large tumours and to less than 1% in small tumours. With large tumours, facial nerve preservation has been possible only in 20% of patients. Large tumours continue to predominate, thus providing a formidable challenge. Saving life and the functions of the lower cranial nerves still form the main goal in the majority of patients who come with large tumours.