Middle fossa approach for acoustic tumor removal.

The middle fossa approach is well suited for the removal of small acoustic tumors with possible hearing preservation. The most appropriate candidates have tumors with less than 5 mm extension into the cerebellopontine angle and good preoperative hearing (speech reception threshold less than or equal to 30 dB, speech discrimination score greater than or equal to 70%). Measurable postoperative hearing can be preserved in 31% to 59% of patients, and normal or near normal facial function occurs in 86% to 89%. Serious postoperative complications are rare with this approach. With the advent of gadolinium-enhanced MRI, it is now possible to diagnose acoustic tumors reliably when small and before hearing has been significantly affected. The middle fossa approach provides excellent access for the removal of these small tumors.