Contemporary otomicrosurgical techniques have made it possible to remove and acoustic tumor en bloc with preservation of the seventh and sometimes the eighth cranial nerves. The four approaches currently used in cerebellopontine angle (CPA) tumor surgery are the middle cranial fossa, the translabyrinthine, the suboccipital and the combined approach. There are several advantages to the combined approach when employed by an otologist and neurosurgeon team. Morbidity and mortality rates are lowered considerably by this method, especially large tumors of the CPA. Recently we have experienced four cases of large CPA tumor through combined approach such as translabyrinthine-suboccipitdal approach, translabyrinthine-subtemporal transtentorial approach, transotic-suboccipital approach and transotic-subtemporal transtentorial approach. So we would like to report methods and cases with brief review of literature.