Middle Fossa Approach for Acustic Neuroma Surgery

Introduction: Acustic neuromas surgery approaches should take into account several variables such as the preferred location of the tumor, the size, previous hearing, and the patient’s expectations. Objectives: The authors report the experience of our department with middle fossa approach. Patients: Ten patients were operated within 12 years period. Results: The main presenting symptom was unilateral tinnitus and hearing loss (intracanalicular tumors between 7 and 16 mm). Total removal was obtained in nine patients. Postoperatively, two patients experienced grade IV House and Brackmann (H&B) or higher facial palsy, and eight patients (80%) with grade I or II. There was one case of late cerebrospinal fluid fistula. There has been no mortality. Conclusion: The middle fossa approach, despite being less and less used, remains a safe and effective approach to treat specific subtypes of tumors and selected patients, particularly when the tumor is intracanalicular (lateral) and hearing is useful, even with increasing risk of facial nerve injury and adding the morbidity of a supratentorial craniotomy.