Translabyrinthine Approach to Acoustic Neuroma
The translabyrinthine approach is the most direct route to resection of the tumor. This approach affords the widest view of the skull base and is commonly used for larger tumors or for tumors that have caused a significant hearing loss. The approach requires a significant amount of bone drilling, approaching the tumor through the skull bone behind the ear thus limiting exposure and potential damage to the brain itself. In this approach, the inner ear is sacrificed and thus there will be no hearing at all after the tumor is resected.
In the translabyrintine approach, the bone behind the ear, the mastoid bone is removed first. In this approach, a fairly imperceptible incision is made behind the ear itself. Drilling of the bone in the mastoid cavity, which lies immediately behind the ear canal, is performed and the bone over the dura of the brain is slowly removed. Layer after layer of bone is carefully removed, gaining more access to the dura and the area that will allow greatest access to the tumor itself. It should be made clear that retractors, or anything that puts pressure on the brain itself, are never used in this approach, or in any surgical procedure performed at The Center for Acoustic Neuroma.
Specifically in this approach, all of the preparation for tumor removal is done extra-dural—outside of the dura with no brain exposure. This allows for a very safe approach and little risk to the brain itself. As the approach continues deeper and deeper, the inner ear is exposed as the bone is removed, lying directly between the tumor and the outside world. Dissection continues through this bone and the tumor is encountered typically in the internal auditory canal, the tunnel that carries the nerves from the brain to the inner ear. Once this tunnel is exposed, bone is removed from this area so that the tumor and the 3 nerves that lie in this tunnel may be accessed, protected, and tumor removed from the facial nerve which is the most important of these nerves as it supplies motion to that side of our face. Once this is exposed, the dura over the brain is opened and the tumor is removed with care.
