Translabyrinthine approach to the cerebellopontine angle

The translabyrinthine approach is one of the most widely used approaches to assess cerebellopontine angle (CPA), particularly for the removal of vestibular schwannomas. It became popularized by William House and William Hitselberger in the 1960s. It has the advantage over other approaches of accessing the CPA at the expense of bone rather than through brain retraction and allows identification of the facial nerve both proximally and distally, thereby assisting nerve preservation during tumor removal. It also provides excellent access for the removal of the intracanalicular portion of tumors. It does, however, require removal of the vestibular apparatus and therefore sacrifices hearing. It may be used in conjunction with other surgical approaches or extended to include removal of the cochlea in order to access the extremities of the CPA or the petrous apex. Indications for the use of the approach and the surgical technique are described including tips to optimize surgical outcome. Complications that might arise following surgery are also discussed.