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Acoustic Neuroma Center
Treatment options
Treatment evaluation process
Stereotactic radiosurgery
Surgical approach
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Barrow Neurological Institute


Surgical Approach to Acoustic Neuroma Treatment

Typically, acoustic neuroma patients are first evaluated by a neurotologist and are then referred to the neurosurgeon for further discussion about surgery. There are multiple surgical approaches available to remove the tumor. Our center has modified many established surgical procedures and developed new surgical approaches to access tumors in the cerebellopontine region.

One of the following approaches to treatment of acoustic neuroma is frequently utilized at Barrow:

  • Transcochlear approach
  • Translabyrinthine approach
  • Retrolabyrinthine approach
  • Far Lateral approach
  • Combined approach
  • Middle fossa approach
  • Retrosigmoid approach

The recommended surgical approach is discussed with the patient in detail after all the factors have been considered. The risks, potential complications, and outcomes (both short-term and long-term) are discussed with the patient and family/support person(s).

Middle Fossa Approach for Acoustic Neuroma Treatment

Middle Fossa Approach

The middle fossa approach in the treatment of acoustic neuroma is completed through a temporal craniotomy in front of the ear. The surgeons then elevate the brain and drill the bone over the top of the tumor and nerves. The main benefit is that there is a very good chance at hearing preservation. The disadvantage is its usefulness for smaller tumors and it may carry a slightly higher risk of facial weakness.


Retrosigmoid Approach for Acoustic Neuroma Treatment


Retrosigmoid Approach

The retrosigmoid approach in the treatment of acoustic neuroma is done through an incision behind the ear. The bone over the sigmoid sinus is drilled. The sigmoid sinus is a large vein encased in the bone behind the ear. The advantage to this approach includes the absence of size limitation; increase of hearing preservation and the risk of spinal fluid leakage is low. The disadvantage of this approach is that if the tumor extends far laterally out the internal auditory canal, complete removal can be difficult. The facial nerve is out of the surgeon's view.  This may increase the risk of facial weakness post-operatively.

Translabyrinthine Approach

The translabyrinthine approach in the treatment of acoustic neuroma is performed through a "C" shaped incision behind the ear. The bone in front of the sigmoid sinus is drilled out, and then the semicircular canals are drilled to expose the most lateral extent of the tumor. The semicircular canals are small fluid filled tubes encased in bone that assists with balance function. The hearing is sacrificed in the translabyrinthine approach so it is ideally suited for those patients who are deaf or have no hearing in the affected ear.

There is no limitation of tumor size with this approach. The main advantage is that the facial nerve is identified early in the operation increasing the likelihood of preserving good or normal facial function post-operatively. The disadvantage is that there is a slightly higher chance of spinal fluid leakage, hearing is sacrificed and a small incision is required in the abdomen to harvest fat used to pack in the defect at the end of surgery.