[Enlarged trans-temporal crania fossa approach. Technique and indications]

The authors report their experience using an enlarged middle cranial fossa approach for the removal of 33 acoustic neurinomas and 10 cerebellopontine angle meningiomas. The Technique is defined. This approach proved suitable for stage I neurinomas, ensuring total removal in all 13 patients with stage I lesions, hearing conservation in 9 (69.2%) of these patients, grade 1 + 2 facial nerve function in 80% of patients and grade 3 function in 20% of patients. While total removal was always possible for stage II neurinomas, the functional results were poor with hearing conservation in only 3 of 15 patients (20%), grade 1 + 2 facial nerve function in 45% of patients and grade 3 function in 54% of patients. Total removal was possible in only 1 of 4 patients with stage III neurinomas. This approach proved excellent for cerebellopontine anale meningiomas, providing wide access to the tumor and protecting the acoustico-facial bundle situated behind the tumor. Among the 10 patients operated by this route, 8 had conservation of hearing and all 10 had normal facial motricity (grade I) at 3 months.