Middle fossa approach to vestibular schwannomas

The middle cranial fossa (MCF) approach for vestibular schwannoma microsurgery is an important tool for the lateral skull base surgeon. In addition to providing excellent visualization of the entire internal auditory canal (IAC), it is one of the few surgical approaches (and possibly the most effective) that allows for postoperative hearing preservation. The MCF approach is the only way to directly visualize the lateral aspect of the IAC while leaving the cochlea and vestibular organs intact. Over the past 60 years, the MCF approach has been adopted in some centers and its outcomes are well documented. Here, the historical context, surgical considerations, patient factors, potential pitfalls, preoperative evaluation, surgical techniques, and outcomes of vestibular schwannoma surgery using the MCF approach are outlined.