TRANSLABYRINTHINE DRILLOUT FROM SUBOCCIPITAL APPROACH TO ACOUSTIC NEUROMA

The suboccipital approach to acoustic neuroma surgery is used when pre servation of hearing is desired or when the surgeon prefers the approa ch even when hearing cannot be saved. Its major disadvantages are poor exposure of the lateral internal auditory canal and lack of precise b ony landmarks to identify the facial nerve. When hopes for preservatio n of hearing are abandoned and complete removal of tumor is considered paramount, a wider drillout of the posterior temporal bone may be acc omplished through the suboccipital approach. The posterior semicircula r canal may be opened and followed into the vestibule. A translabyrint hine exposure of the vertical crest and full length of the internal au ditory canal is readily obtained. Translabyrinthine drillout procedure s were performed in 14 patients, and the technique was expedient and y ielded excellent exposure. An abdominal fat graft was not required, an d only one instance of leakage of cerebrospinal fluid occurred. Transl abyrinthine drillout from the suboccipital approach is a useful adjunc t when sacrifice of hearing is indicated.