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Presigmoid Approaches to Posterior Fossa: Translabyrinthine and Transcochlear
There are multiple variations of the presigmoid approach to the posterior fossa: retrolabyrinthine, transcrusal, translabyrinthine, transotic, and transcochlear. Each variation increases the amount of temporal bone resected, which increases the surgical freedom at the expense of increased surgical morbidity of cranial nerves VII and VIII. In this chapter, we focus on the translabyrinthine and transcochlear approaches (retrolabyrinthine is described in Procedure 20).
Translabyrinthine approach
Indications
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The rationale for this approach includes exposure of the posterior fossa and 180- to 270-degree exposure of the internal auditory canal (IAC) circumference while sacrificing any residual hearing.
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Indications include removal of cerebellopontine angle lesions with preoperative unserviceable hearing, regardless of lesion size (e.g., vestibular schwannoma, meningioma, epidermoid, dermoid).
Contraindications
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Lesions extending anteriorly to prepontine cistern.
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Ipsilateral chronic otitis media (relative).
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Only hearing ear.
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