Surgical Approaches to Acoustic Tumors

THE purpose of this discussion is to describe the techniques now used to gain access to the cerebellopontine angle for removal of acoustic tumors. We will assess these techniques relative to how they fulfill the principles and criteria which we have set up to gauge the effectiveness of the particular surgical technique used. These principles are as follows:

1. Avoidance of further cranial nerve damage

2. Adequate decompression of the posterior fossa

3. Avoidance of injury to the brain stem or cerebellum

4. Satisfactory access for removal of the tumor and management of any postoperative complications.

The operations used today are of four types:

1. Middle fossa approach

2. Translabyrinthine approach

3. Suboccipital approach

4. Combined suboccipital-petrosal approach.

We will review each of these procedures relative to how they accomplish the aim of total removal of the tumor within the framework of the above-stated requirements.

Middle Fossa Approach  The middle