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

Area of Science:

• Neurosurgery
• Otolaryngology
• Oncology

Background:

• Acoustic neurinomas and cerebellopontine angle meningiomas are challenging tumors.
• Surgical approach selection is critical for maximizing tumor removal and preserving neurological function.

Purpose of the Study:

• To evaluate the efficacy and outcomes of the enlarged middle cranial fossa approach for acoustic neurinomas and cerebellopontine angle meningiomas.
• To assess tumor removal rates and functional preservation of hearing and facial nerves.

Main Methods:

• Retrospective analysis of 33 acoustic neurinomas and 10 cerebellopontine angle meningiomas treated with the enlarged middle cranial fossa approach.
• Detailed assessment of total tumor removal, hearing preservation, and facial nerve function (House-Brackmann grading).

Main Results:

• For stage I acoustic neurinomas, total removal was achieved in all patients with good hearing and facial nerve function preservation.
• Functional outcomes, including hearing and facial nerve function, significantly decreased with advanced stages (II and III) of acoustic neurinomas.
• The approach yielded excellent results for cerebellopontine angle meningiomas, with high rates of hearing preservation and normal facial nerve function.

Conclusions:

• The enlarged middle cranial fossa approach is highly effective for cerebellopontine angle meningiomas.
• This surgical technique is suitable for early-stage acoustic neurinomas, but its efficacy diminishes with tumor size and stage.
• Careful patient selection is crucial for optimizing outcomes with this approach in acoustic neuroma surgery.