目的　探讨治疗大型听神经瘤的最佳手术方法。方法　采用患侧枕下乙状窦后入路 ,应用显微外科技术 ,定期随访。结果　肿瘤全切率 84 .2 % (6 4 / 76 ) ,面神经解剖保留率 87.1% ,术前有听力者听神经保留率 51.7% ,无手术死亡。平均随访 4 .6年未见肿瘤复发。结论　采用显微技术行大型听神经瘤经枕下乙状窦入路切除术 ,是提高肿瘤全切率和面、听神经保留率 ,降低死亡率的重要手段 Objective To explore the best surgical method for the treatment of large acoustic neuroma. Methods The posterior suboccipital sigmoid sinus approach was used, and microsurgical techniques were used for regular follow-up. Results The total tumor resection rate was 84.2% (6 4 / 76), the anatomical retention rate of facial nerve was 87.1%, and the auditory nerve retention rate before hearing was 51.7%. There was no operative death. There was no recurrence of the tumor after an average follow-up of 4.6%. Conclusion The use of microsurgery for transcerebral sigmoid sinusectomy for large acoustic neuromas is an important means to increase the total tumor resection rate, surface and auditory nerve retention, and reduce mortality.