Middle fossa approach for removal of acoustic neuroma: case reports and literature review

There are 3 approaches for the surgical treatment of acoustic neuroma namely: 1) translabyrinthine approach 2) retrosigmoid approach, and 3) middle fossa approach. The middle fossa approach was used for the removal of small or intracanalicular tumors, with or without serviceable hearing. The first case presented with severe right sensorineural hearing loss and facial palsy; the second with progressive sensorineural hearing loss. MRI showed an intracanalicular acoustic tumor without cerebellopontine angle extension. The middle fossa approach for tumor removal was done in both cases without any serious complication. In the first case, the function of the facial nerve returned from grade V to grade III (House-Brackmann grading system), and the hearing of the second case was preserved. This is the first report which shows that the middle fossa approach is safe in selected case for surgical removal of acoustic neuroma.