Surgical approaches to the human cochlear nuclear complex

Patients with bilateral neural deafness may be candidates for rehabilitation with a device that provides direct electrical stimulation of the central nervous system. The cochlear nuclear complex at the pons-medulla junction is a logical site to implant because it is in the surgical field exposed for acoustic tumor surgery. In this study we compared four surgical approaches commonly used to reach the cerebellopontine angle for ease of access to the cochlear nuclear complex. We found the translabyrinthine approach to be the most satisfactory because the anterior approach facilitates identification of key landmarks, such as the tenia of the choroid plexus and the lateral recess of the fourth ventricle. The suboccipital, or retrosigmoid, approach would be satisfactory after removal of a large acoutic tumor; however, the amount of cerebellar retraction necessary may preclude its use in nontumor cases.