Abstract： Objective To study the clinical characteristics,surgical strategy and outcomes of large cystic acoustic neuromas based on our experience.Method A retrospective study of clinical presentation and surgical outcomes was performed on 74 patients with large acoustic neuromas, of which 24 were cystic and 50 were solid.Results Atypical initial symptoms, shorter clinical history and more frequent incidence of preoperative hydrocephalus were characteristics of large cystic acoustic neuromas differed from solid tumors.Gross total resection was performed in 17(71%) patients with cystic tumors and 45(90%) patients with solid tumors, subtotal resection in 6 (25%) and 5 (10%),respectively.The anatomical preservation of facial nerve was achieved in 20 patients (83%) with cystic tumors versus 45 patients (90%) with solid tumors.Conclusions Large cystic acoustic neuromas have a rapid growth pattern and should be given early surgical treatment.The surgical strategy of subtotal resection is indicated for large cystic acoustic neuromas with severe adherence in order to preserve facial nerve function.