Transcochlear and Extended/Combined Transcochlear Approaches for Complex Tumors of the Skull Base and Posterior Cranial Fossa

Abstract

There is no single optimal approach for all skull base pathologies and locations. Skull base surgeons must tailor their surgery to both the tumor and the goals of care for the patient to optimize conditions for tumor removal while minimizing morbidity. Lateral skull base approaches are an attractive option to access the skull base given the direct surgical access to the lower cranial nerves, the intra- and extratemporal internal carotid artery (ICA), and the venous sinuses. These approaches can be broadly classified as otic capsule-sparing and otic capsule-sacrificing. These approaches are complex in nature, and patient selection on a case-by-case basis with multidisciplinary input is essential. Complex skull base tumors may not be adequately addressed with a single surgical approach and may require a combination or modification of these techniques. In this chapter, we will describe transcochlear approaches and how they can be modified to provide extended skull base access.