Translabyrinthine drillout from suboccipital approach to acoustic neuroma

The suboccipital approach to acoustic neuroma surgery is used when preservation of hearing is desired or when the surgeon prefers the approach even when hearing cannot be saved. its major disadvantages are poor exposure of the lateral internal auditory canal and lack of precise bony landmarks to identify the facial nerve. When hopes for preservation of hearing are abandoned and complete removal of tumor is considered paramount, a wider drillout of the posterior temporal bone may be accomplished through the suboccipital approach. The posterior semicircular canal may be opened and followed into the vestibule. A translabyrinthine exposure of the vertical crest and full length of the internal auditory canal is readily obtained. Translabyrinthine drillout procedures were performed in 14 patients, and the technique was expedient and yielded excellent exposure. An abdominal fat graft was not required, and only one instance of leakage of cerebrospinal fluid occurred. Translabyrinthine drillout from the suboccipital approach is a useful adjunct when sacrifice of hearing is indicated.