EVOLUTION of the surgical management of acoustic neuromas during the first half of this century culminated in the consensus that a total removal is preferable to a subtotal removal, and that preservation of the facial nerve is an extravagance if it forces a subtotal removal. Horrax,1 in 1950, reported a representative experience. He cited a 56% five-year mortality and 25% useful survival for Cushing's series of subtotal removals, as compared to his own 14% five-year mortality and 62% useful survival for a series with total removals. Techniques and attitudes remained fixed over the next decade.
Kurze and Doyle,2 and House,3 shared early experiences with a microsurgical approach to the internal auditory canal through a middle fossa approach. Seeking a more commodious approach, Rand and Kurze4 developed the posterior fossa transmeatal microdissection technique, opening the posterior wall of the internal auditory canal through the conventional suboccipital approach.
Hood H. Advances in Removal of Acoustic Neuromas: The Suboccipital Approach. Arch Otolaryngol. 1968;87(6):651–658. doi:10.1001/archotol.1968.00760060653020
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