Middle fossa approach: indications, technique, and results.

This article discusses the indications, surgical technique, results, and complications of middle fossa craniotomy (MFC) for vestibular schwannoma surgery, focusing on issues such as serviceable hearing, tumor characteristics, and patient-specific factors that help determine options for therapy. MFC is suitable for intracanalicular vestibular schwannomas that extend less than 1 cm into the cerebellopontine angle in patients with good hearing. With the expanding use of modern imaging, many small tumors are being identified in patients with no or minimal symptoms. Patients with these tumors have three therapy options: (1) stereotactic radiotherapy, (2) microsurgery, and (3) observation (ie, wait-and-scan approach).