Acoustic neuroma: surgical approaches and complications

Acoustic neuroma is the commonly used term for benign schwannomas arising from the vestibular divisions of the eighth cranial nerve. They are relatively common lesions and present a therapeutic challenge. Three approaches are used for removal of acoustic neuromas: middle fossa, retrosigmoid, and translabyrinthine. Each approach has advantages and disadvantages. The advantage of the middle fossa and retrosigmoid approaches is the possibility of preserving hearing. Both require more brain retraction and have greater risk to the facial nerve than the translabyrinthine approach. The translabyrinthine approach sacrifices hearing but has lower incidence for all other complications. The details of each of these surgical approaches are described. The advantages and disadvantages of each approach are detailed, and then the complications which are common to the procedures are described.