THE TRANSOTIC APPROACH IN ACOUSTIC NEUROMA SURGERY

A consecutive series of 147 transotic operations for the removal of ac oustic neuroma is presented. The advantages of this approach over the conventional translabyrinthine technique are several, including 1) a w ider surgical access with a circumferential exposure of the internal a coustic meatus and the porus acousticus; 2) the direct visualization a nd access to the anterior cerebellopontine angle where the facial nerv e is usually tenuous arid most vulnerable; and 3) the permanent closur e of the ear canal and eustachian tube with complete obliteration of t he surgical cavity, minimizing cerebrospinal fluid leaks. These advant ages have translated into improved surgical outcomes. In our series of 147 patients spanning 11 years, total tumor extirpation was achieved in all patients, with one mortality, three CSF leaks, and one meningit is. The facial nerve was anatomically preserved in 95% of the cases. T his approach is capable of attaining the widest, and the most direct a ccess to the cerebellopontine angle without cerebellar retraction.