Middle cranial fossa approach to acoustic neuromas: A comparison to the suboccipital approach

Since 1976, we have operated on more than 900 acoustic neuromas using the extended middle cranial fossa approach (EMCF). The EMCF is a combination of the middle cranial fossa approach with a tentorial opening and the posterior petrosal (extended translabyrinthine) approach. This approach includes auditory canal unroofing for intracanalicular tumors, an additional tentorial incision for small sized tumors, and an additional posterior petrosectomy and mastoidectomy for medium and large tumors. The advantages of the EMCF are easy exposure of the intracanalicular tumor and early identification of the facial nerve. Less invasive dissection of the brainstem is accomplished using the EMCF than the suboccipital approach in large tumors. However, contact damage to the facial nerve must be avoided during tumor resection.