The enlarged transtemporal middle fossa approach to the cerebello-pontine angle is adequate for complete removal of acoustic neuromas up to 4.0 cm in diameter (sizes B and C according to Fisch). A description of the surgical technique and the results of 63 operations are presented (13, 23 and 27 tumours of sizes A, B and C respectively). 51 tumours were completely removed, 6 had a voluntary palliative incomplete resection for medical reasons or on the only remaining hearing ear. Only 6 patients (one in the last 40 consecutive cases) had an incomplete resection due to the limited exposure of the tumour. In 44 ears the cochlear nerve could be preserved, 28 of which showed postoperative hearing function (8 size A, 10 size B, 10 size C). There was no operative mortality, no severe hemorrhage nor any permanent neurological complication. The facial nerve function was well preserved in 48 of 56 patients followed up.