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Middle Fossa Approach

Last Updated: February 18, 2020

Resection of an Acoustic Neuroma through the Middle Cranial Fossa Approach

For general considerations, clinical presentation, and evaluation of vestibular schwannomas (VSs), please refer to the Retrosigmoid Approach for Acoustic Neuroma chapter.

Indications for the Middle Cranial Fossa Approach

The main indications for the middle cranial fossa (MCF) approach include removal of a small predominately intracanalicular VS, exposure of the labyrinthine and upper tympanic segments of the facial nerve for decompression, vestibular nerve section, and repair of superior semicircular canal dehiscence.

Historically, the MCF approach offers some of the highest hearing preservation rates, but it can also place the facial nerve between the surgeon and the tumor, potentially leading to a higher risk of postoperative facial weakness. In some cases, this configuration results in the need for blind dissection.

This route also requires some retraction on the temporal lobe, with the ensuing potential risk of postoperative seizures and speech disturbances, while providing a limited view of the cerebellopontine (CP) angle.