Classification of the extended middle cranial fossa approach

There are several possible operative approaches to acoustic neuroma surgery. Ideally, there should be no need to select among approaches according to tumor size or indications for hearing preservation. The ideal approach should also allow otologists and neurosurgeons to work as a team using the same operative field and achieve functional preservation (facial nerve function and hearing) in a high percentage of cases. In 1977, the authors first reported on the extended middle cranial fossa (EMCF) approach for AN surgery. Based on our 15-year experiences of this approach, we have classified it into 3 types and describe their indications and techniques in the present paper. In addition, we examine the advantages and disadvantages and emphasize its excellent applicability as a team approach for otologists and neurosurgeons.