The middle cranial fossa approach provides extradural exposure to the internal auditory canal (IAC) via a subtemporal route. It offers the possibility of total removal of small intracanalicular vestibular schwannomas while preserving hearing. The first advantage of the approach is that it includes exposure of the lateral end of the IAC, which ensures removal of tumor that otherwise may be difficult to reach from the suboccipital transmeatal approach. The second advantage of the approach is that positive identification of the facial nerve at the lateral end of the IAC facilitates tumor dissection from the facial nerve.