Objective: the authors reviewed the clinical manifestations and the surgical outcomes in a series of young patients who underwent removal of large acoustic neuromas via the translabyrinthine approach. Methods: 40 young adults who underwent a translabyrinthine removal of acoustic neuromas 3cm or greater in size were analyzed. The patient's age ranged from 17 to 30 years. The mean size of tumor was 4.25cm. Results: the primary symptoms are similar to those in adult but usually less intense. The average interval time between the primary symptom and the diagnosis was 17 months. A high percentage of preoperative normal hearing (35%) and good facial function (100%) were noted. Translabyrinthine approach was used in all cases. Total removal was realised in 39 patients (97.5%). The facial nerve was anatomically preserved in 37 patients (92.5%). Twenty-six patients (65%) had a good facial function (House-Brackmann grade I or II) immediately or at 1 month after surgery, 11 patients (28%) achieved grade III or IV. Three patients underwent an immediate nerve repair after tumor removal. All of them recovered to grade III or IV 1 year after surgery. Postoperative complications were minimal. Conclusions: young adults may have a rapid growth rate but usually have minimal symptoms even with a large acoustic neuroma. The translabyrinthine approach has been used successfully in removal of large acoustic tumors of young patients, with the good result of facial nerve preservation and long-term tumor control.