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Middle fossa approach for resection of vestibular schwannoma

Abstract

Background

Surgical approaches for removal of vestibular schwannoma are done through retrosigmoid, translabyrinthine, or middle fossa approaches, depending on the tumor size, preoperative hearing status, surgical team experience, and patient preference. The middle fossa approach (MFA) for the vestibular schwannoma (VS) route preserves hearing and can be done with minimal morbidity and mortality.

Method

The authors discuss the surgical anatomy of the middle fossa, internal auditory canal localization techniques, MFA indications and the procedure for VS removal, and outcome.

Conclusion

Unlike otolaryngologists, who use the MFA to treat various pathological processes that involve the inner or middle ear, many neurosurgeons are unfamiliar with the MFA. Nevertheless, learning the technical nuances of the MFA adds to the neurosurgeon’s armamentarium, especially for treatment of small intracanalicular VSs in young patients who wish to preserve hearing.

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Fig. 1

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Author information

Correspondence to William T. Couldwell.

Electronic supplementary material

Video illustrating the middle fossa approach technique used by the authors for resection of the vestibular schwannoma. In this case, a right middle fossa approach was used for resection of intracanalicular vestibular schwannoma. (MP4 231,994 kb)

Video 1

Video illustrating the middle fossa approach technique used by the authors for resection of the vestibular schwannoma. In this case, a right middle fossa approach was used for resection of intracanalicular vestibular schwannoma. (MP4 231,994 kb)

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Alzhrani, G., Shelton, C. & Couldwell, W.T. Middle fossa approach for resection of vestibular schwannoma. Acta Neurochir 159, 1023–1026 (2017). https://doi.org/10.1007/s00701-017-3169-1

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Keywords

  • Middle fossa approach
  • Vestibular schwannoma
  • Resection
  • Hearing