Indications and variations of transcochlear exposure of the ventral brainstem

The transcochlear exposures represent a spectrum of three approaches (transotic to transcochlear to transpetrous) that provide progressively wider lateral skull base exposure. The approaches all combine the translabyrinthine approach with removal of the cochlea. The facial nerve remains in situ in the transotic approach. The facial nerve is mobilized posteriorly in the transcochlear approach, and the transpetrous exposure adds resection of the petrous apex with carotid artery mobilization. This report focuses on the indications for each of the variations of transcochlear exposure. These lateral skull base exposures can be individualized to the needs of each patient.