Neurootosurgical considerations in microsurgery of acoustic neuromas via the enlarged middle cranial fossa approach

During recent years there has been a lot of controversy about the advantages and disadvantages of different approaches in acoustic neuroma surgery. 327 patients with a unilateral acoustic neurinoma were operated on via the enlarged middle cranial fossa approach (EMCFA). A total tumor removal was achieved in 98 % of cases. The mortality rate was 0,6 %. Overall in acoustic neurinoma surgery, the percentage rates of meningitis (1,5 %), cerebrospinal fluid fistula (1,5 % requiring surgery) and neurological deficits, were quite low. The facial nerve could be preserved anatomically in 99,7 %. In all cases there was a House I classification in 80 %, in small tumors 95 %. It was possible to preserve the hearing function in 49 % of all patients (73 % in small tumors). Positive effect of tinnitus usually occurred in 45 % of cases. The recurrence rate in the postoperative MRJ follow up after total removal of acoustic neuromas was 0,8 %. The enlarged middle cranial fossa microsurgery allows function-preserving surgery including total removal of large acoustic neurinomas with an extrameatal diameter of up to 3 cm.