Surgery was indicated to decompress the brainstem and save patient’s life. The aim of surgery was also to remove completely these large and giant residual/recurrent tumors and cure the patient. Radical removal was possible in all cases (Table 25.2). The surgical procedure was much more difficult than in nonoperated cases. From the beginning of surgery, fibrosis caused by the previous procedure(s) difficult dissection of the dura mater and identification of the sigmoid sinus. Careful dissection was necessary in order to not injure the sigmoid sinus. After dura opening there, no clear arachnoid plane could be found. The cases submitted to radiotherapy presented even more adherences. Dissection and preservation of cranial nerves, vessels, and brainstem was the main task of surgery. Monitoring of facial and caudal cranial nerves helped to preserve these structures. When the IAC had not been opened by the previous surgery, identification and dissection of the facial nerve and removal of the intracanalicular portion of the VS within the IAC was less difficult. Postoperative anatomical preservation of the facial nerve was possible in eight of nine patients with preoperative facial nerve function. Reconstruction of facial nerve through hypoglossal-facial anastomosis was performed 2 or 3 weeks after surgery in seven of the remaining eight cases. House and Brackmann facial palsy grades III–IV were obtained in these patients.