MANAGEMENT OF THE CONTRACTED MASTOID IN THE TRANSLABYRINTHINE REMOVALOF ACOUSTIC NEUROMA

Several approaches to the internal auditory canal and cerebellopontine angle for acoustic neuroma removal have been described. We prefer the translabyrinthine approach in patients with tumors larger than 2 cm o r poor preoperative hearing, since both factors predict poor hearing p reservation. Many surgeons perceive this approach as confining and con sider it contraindicated in large tumors or contracted mastoids. We ha ve recently described the utility of the translabyrinthine approach fo r the removal of large (>4 cm) acoustic neuromas. In more than 5000 tu mor excisions performed by the senior author (W.E.H.), no cases requir ed a modification of the approach because of anatomic constraints with in the mastoid. We describe our techniques for the management of the l ow-lying tegmen, the anterior sigmoid sinus, and the high jugular bulb , alone or in combination, during translabyrinthine removal of acousti c neuromas.