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Acoustic Neuroma Surgery: Middle Fossa Approach
Book chapter

Acoustic Neuroma Surgery: Middle Fossa Approach

Daniel Q. Sun and Bruce J. Gantz
Surgery of the Cerebellopontine Angle, pp.189-195
Springer International Publishing
01/01/2023
DOI: 10.1007/978-3-031-12507-2_14

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Abstract

The middle cranial fossa (MCF) approach was first reported in 1904 and then popularized by William House in 1961 for the excision of small intracanalicular vestibular schwannoma (VS) [1]. In contrast to translabyrinthine and retrosigmoid approaches, it offers superior exposure of the distal internal auditory canal (IAC) and identification of the labyrinthine facial nerve that is uninvolved by tumor, without sacrificing hearing. It is a technically challenging procedure due to the lack of reliable landmarks in the middle fossa and that the facial nerve is commonly displaced between the surgeon and the tumor, placing it at additional risk for injury. However, the advent of facial nerve monitoring and steady evolution in technique have rendered it a safe and effective procedure that is ideally suited to the microsurgical excision of a small VS when hearing preservation is an important goal. In discussing hearing outcome, this chapter uses American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) and word recognition score (WRS) hearing classification schemes (Fig. 14.1). This chapter focuses on the use of the MCF approach in the treatment of small VS. The surgical management of other surgical pathologies in the temporal bone or cerebellopontine angle (CPA) using an MCF approach or variants thereof, such as extended MCF or transpetrosal approaches, is beyond the scope of this chapter.

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