Transapical extension in difficult cerebellopontine angle tumors

The transapical extension of the enlarged translabyrinthine approach is aimed at making the removal of certain tumors of the cerebellopontine angle simpler and with less morbidity. The extension is classified into 2 types--type I and type II--based on the extent of bone drilling around the internal auditory canal. Type I extension involves drilling for 300 degrees to 320 degrees around the canal and is indicated for large or giant vestibular schwannomas and vestibular schwannomas with significant extension anterior to the internal auditory canal. Type II extension entails complete removal of the bone around the canal for 360 degrees and is indicated for meningiomas of the posterior surface of the petrous bone extending anterior to the internal auditory canal. The extension allows better control over the anterior pole of the tumor, the displaced facial nerve, the prepontine cistern, and the venous vascularity of the cerebellopontine angle. The aim of this report is to present our experience with this extension.