Extended middle fossa and retrolabyrinthine approaches in acoustic neuroma surgery: case reports

Hearing conservation surgery for small acoustic neuromas is well accepted. At present, two approaches are primarily used: the suboccipital and the middle fossa. The middle fossa approach to the internal auditory canal has the advantage of using bony landmarks to identify and protect the facial nerve. Because of anatomic constraints presented by the superior semicircular canal however, its uses are limited to intracanalicular tumors or tumors protruding only slightly into the cerebellopontine angle. By extending the approach through the superior semicircular canal, a wide access to the cerebellopontine angle can be safely obtained. In this study three procedures, two through the superior semicircular canal and one through the posterior semicircular canal, were utilized for hearing conservation surgery. By immediately sealing off the canal ends, hearing preservation was accomplished in two out of three of these cases. The dictum that labyrinthine opening invariably leads to anacusis should be reconsidered. By utilizing approaches through the semicircular canal, it is possible that morbidity from this surgery may be reduced.