Choice of surgery is determined by whether preservation of hearing is wanted or not: If preservation of hearing is wanted then: Large Tumour: Suboccipital Approach Small lateral Tumour: Middle fossa approach If preservation of hearing is not a priority then in any size tumour Translabyrynthine approach is followed. Trans-labyrinthine Approach Indications: Non-serviceable hearing • Advantages: There is little cerebellar retraction during the surgical procedure. There is good exposure of facial nerve laterally All size tumours can be handled with this approach.
• Disadvantages: There hearing is sacrificed and slightly higher CSF leak rate. Middle Fossa Approach: Indications Intracanallicular tumor (maybe 0.5cm into IAC) Residual Hearing Contraindications Large tumors Older patients ( > 60 yrs. may have higher rate of bleeding or stroke) Advantages The middle fossa approach perhaps has the…
