The transotic approach in acoustic neuroma surgery.

A consecutive series of 147 transotic operations for the removal of acoustic neuroma is presented. The advantages of this approach over the conventional translabyrinthine technique are several, including 1) a wider surgical access with a circumferential exposure of the internal acoustic meatus and the porus acousticus; 2) the direct visualization and access to the anterior cerebellopontine angle where the facial nerve is usually tenuous and most vulnerable; and 3) the permanent closure of the ear canal and eustachian tube with complete obliteration of the surgical cavity, minimizing cerebrospinal fluid leaks. These advantages have translated into improved surgical outcomes. In our series of 147 patients spanning 11 years, total tumor extirpation was achieved in all patients, with one mortality, three CSF leaks, and one meningitis. The facial nerve was anatomically preserved in 95% of the cases. This approach is capable of attaining the widest, and the most direct access to the cerebellopontine angle without cerebellar retraction.