THE SYSTEM OF THE MODIFIED TRANSCOCHLEAR APPROACH - A LATERAL AVENUE TO THE CENTRAL SKULL BASE

Objective: This study aimed to update the authors' experience with the modified transcochlear approach for the management of lesions of the central skull base. The surgical technique, classification, indication s, and results also are presented. Study Design: A retrospective revie w of the charts of 66 consecutive patients treated in our centers by t he modified transcochlear approach was conducted, Setting: The study w as performed in two tertiary referral centers. Patients: All patients treated by the modified transcochlear approach were included. Thirty-f ive patients had extradural lesions, whereas 31 lesions were intradura l. Intervention: All patients were treated surgically using the modifi ed transcochlear approach either in its basic form (type A) or with it s extensions (types B, C, and D). Main Outcome Measures: The outcome o f surgery is evaluated with particular emphasis on the incidence of mo rbidity, mortality, and the degree of total tumor removal. Results: To tal tumor removal was accomplished in 58 cases either in single or sta ged procedures. A second-stage procedure for total tumor removal is pl anned in five other patients. Subtotal tumor removal was performed in three patients. Mortality occurred in two cases. Ipsilateral hearing l oss and immediate facial nerve palsy constituted the major drawbacks o f this approach. However, 67.5% recovered to grade III facial function or better 1 year after surgery, Conclusions: The modified transcochle ar approach provides a relatively safe, wide, and versatile access to large lesions of the central skull base.