Middle fossa approach for acoustic tumor removal.

Area of Science:

• Neurosurgery
• Otolaryngology
• Neurosurgical Oncology

Background:

• Acoustic tumors (vestibular schwannomas) are benign tumors that arise from the myelin sheath of the vestibulocochlear nerve.
• Early diagnosis of small acoustic tumors is crucial for successful surgical removal and hearing preservation.
• The middle fossa approach offers a specialized surgical route for accessing tumors located in the cerebellopontine angle.

Purpose of the Study:

• To evaluate the efficacy and outcomes of the middle fossa approach for the surgical removal of small acoustic tumors.
• To identify patient selection criteria for optimal hearing preservation using this surgical technique.
• To assess the rates of hearing preservation, facial nerve function, and postoperative complications associated with the middle fossa approach.

Main Methods:

• Retrospective or prospective analysis of patients undergoing middle fossa craniotomy for acoustic tumor removal.
• Detailed assessment of preoperative audiometric data (speech reception threshold, speech discrimination score) and tumor size (cerebellopontine angle extension).
• Evaluation of postoperative hearing, facial nerve function (House-Brackmann scale), and complication rates.

Main Results:

• The middle fossa approach is suitable for tumors with <5 mm cerebellopontine angle extension and good preoperative hearing (SRT ≤30 dB, SDS ≥70%).
• Postoperative hearing preservation is achieved in 31%–59% of patients.
• Excellent facial nerve function (86%–89% normal/near normal) and low complication rates are observed.

Conclusions:

• The middle fossa approach is a highly effective surgical technique for removing small acoustic tumors, offering a significant chance for hearing preservation.
• Gadolinium-enhanced MRI facilitates early diagnosis, enabling timely intervention with the middle fossa approach for optimal patient outcomes.
• This approach provides excellent access and favorable functional results, making it a valuable option for select patients with early-stage acoustic neuromas.