Abstract
Objectives: In this case series, we report our experience of microsurgical resection of large and giant CPA tumors at the Department of Neurosurgery, Punjab Institute of Neurosciences (PINS).
 Materials and Methods: This was a retrospective case series of 328 patients (mean age, 40 years) with large and giant CPA tumors (predominantly vestibular schwannomas) who underwent surgical removal using a retro sigmoid approach over 4 years.
 Results: In the study, there were 58% (190) females while 42% (138) were males. 60% (197) of the tumors were right – sided and 40% (131) left – sided. Hearing loss was the main presenting complaint with 73% of the patients having non-serviceable hearing. There were 14 (4.3%) deaths reported during the retrospective analytic study. There were 3 cases of postoperative hemorrhage, and 11 patients expired due to post-operative wound infection. There were 13 cases diagnosed as having post-operative bacterial meningitis. Gross total tumor excision was achieved in 98% of patients based on postoperative imaging. There were 26 cases (8%) with postoperative CSF leakage that was managed with LP drain (5 patients) and in the rest VP shunt was done. Facial nerve function was graded according to the House Brackmann system. It was recorded in all patients following surgery: There were 16% patients with HB grade IV and 216 (66%) patients with HB grade III facial palsy. 
 Conclusion: Suboccipital Retrosigmoid approach is ideal for dealing with giant CPA tumors. Complication rates in our series were comparable with other reported literature.
Highlights
The most common location for tumors in thePak
This is a retrospective data analysis of case series of 328 patients with CPA tumors who were hospitalized at the Punjab Institute of Neurosciences Unit 3 between January 2017 and September 2021
Despite the lack of availability of facial nerve monitoring in our setup, in 70 percent of the cases, anatomical preservation of facial nerve was achieved.[13,14,15] our study demonstrates that size of the tumor and facial nerve preservation are directly correlated
Summary
The most common location for tumors in the. Tariq Imran Khokhar, et al: Giant Cerebellopontine Angle Tumor Surgery: Experience of a Tertiary Care Center in LHR, Pakistan posterior fossa is the CP angle. Ten percent of all cerebral neoplasms are these tumors.[1] Vestibular schwannoma (VS) is the most frequent CP angle tumor, accounting for 80 – 90 percent of all cases. Meningiomas, which account for about 5 – 10% of all tumors, are the second most common. The epidermoid cyst is the third most frequent type of CP angle tumor, accounting for about 5-7 percent of all CP angle tumors. Metastatic lesions, arachnoid cysts, cranial nerve V, VII, IX, X, X neuromas, vascular malformations, aneurysms, cholesterol granulomas, and neurenteric cysts are just a few of the uncommon tumors that can appear in this area.[2]
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