Suboccipital-Translabyrinthine Approach for Acoustic Neuroma

THE IMPORTANCE of total removal of an acoustic neuroma has been emphasized by several authors.1-3,6,11,12Recently, in an excellent monograph, House and coworkers4summarized their results of the translabyrinthine exposure for removal of these tumors. This technique is reported to carry a low morbidity and mortality and gives one the best chance of preserving facial nerve function. Our experience, as well as that of others,10has indicated that total removal of large tumors by the translabyrinthine approach may not be practical and exposure may be difficult. When this technique is used, the separation of tumor adherent to the brain stem and exposure of vital arteries and cranial nerves may be compromised; total removal may not be possible. In the suboccipital exposure, on the other hand, it is quite often difficult to preserve the facial nerve and remove the portion of the tumor in the petrous bone.5,11