Retrolabyrinthine surgery: a direct approach to the cerebellopontine angle

The direct route to the cerebellopontine (CP) angle through the ear (retrolabyrinthine approach) represents a significant advance in neuro-otologic surgery. After incising the dura between the endolymphatic sac and the lateral venous sinus, a self-retaining retractor is used to collapse the lateral sinus, which provides a wide exposure of the CP angle, with visualization of the 5th through 11th cranial nerves. The retrolabyrinthine approach is a safe and direct route to the CP angle and has advantages over the suboccipital approach. Vestibular neurectomy through the retrolabyrinthine approach is the most frequently performed procedure and has replaced middle fossa vestibular neurectomy in our practice.