The Middle Fossa Approach:
This approach is most commonly used for removal of smaller tumors when hearing is still intact. It is particularly suitable for tumors under 1.5 cm and located deep in the internal auditory canal, close to the inner ear. For a complete history of the development of this approach please see this article by Dr. Monfared (http://www.ncbi.nlm.nih.gov/pubmed/19816222). This approach is also used for removal of acoustic neuromas and other disorders, such as superior semicircular canal dehiscence, encephaloceles and facial nerve decompression.
Advantages of the Middle Fossa Approach:
• Very versatile approach for many disorders including small acoustic neuromas.
• Optimal for hearing preservation
Disadvantages of the Middle Fossa Approach:
• Only useful for tumors smaller than 1.5 cm
• Facial nerve is in a disadvantageous position
• Need for retraction of the dura and the temporal lobe
Images used with permission from Robert K Jackler