Middle cranial fossa approach for acoustic neuroma.

Paul W Gidley,Joel Z Passer,Joshua C Page,Franco Demonte

doi:10.3171/2021.7.focvid21124

Paul W Gidley, Joel Z Passer + Show 2 more

Open Access

https://doi.org/10.3171/2021.7.focvid21124

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Abstract

The middle fossa approach for the resection of small acoustic neuromas is a viable, but underutilized treatment modality with the goal of hearing preservation. The authors aim to demonstrate this approach and its nuances through this video presentation. A 38-year-old man presented with an incidentally discovered small, intracanalicular acoustic neuroma that was initially observed, but growth was noted. The patient had good hearing, and therefore a hearing preservation approach was offered. A gross-total resection was achieved, and the patient maintained good hearing postoperatively. This video demonstrates relevant anatomy, surgical indications, technical aspects of resection, including reconstruction, and postoperative outcomes.The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID21124

Highlights

The middle fossa approach for the resection of small acoustic neuromas is a viable, but underutilized treatment modality with the goal of hearing preservation
An imaginary line drawn from the GSPN joins an imaginary line drawn from the arcuate eminence to form an angle that is roughly 90° to 120°
Drilling starts over the arcuate eminence in order to blue-line the superior semicircular canal

Summary

Introduction

The middle fossa approach for the resection of small acoustic neuromas is a viable, but underutilized treatment modality with the goal of hearing preservation. This is Dr Paul Gidley, and this is our middle cranial fossa approach for excision of acoustic neuroma. The internal auditory canal is found by bisecting this angle. The options for management were explained to the patient, and these include observation with serial imaging, microsurgical resection, and stereotactic radiosurgery. Hearing preservation is offered to patients under the age of 65 with small tumors and good hearing.

Results

Conclusion