Temporal Bone and Acoustic Neuroma

Surgery for acoustic tumors has improved dramatically during the last few decades with the application of microsurgical techniques. Surgical results no longer include mortality as a significant variable, and outcome is measured in terms of preservation of the facial nerve and hearing. Patients with small tumors and intact hearing have the best chances for preservation of both the facial and cochlear nerves, whereas patients with moderately sized tumors still have satisfactory neurological outcomes. For hearing preservation in patients with small and medium tumors, the posterior fossa and middle fossa approaches yield good results. In cases of large tumors with no ser-viceable hearing, the translabyrinthine, the transotic, and the suboccipital retrosig-moid approach yield comparable results. Selection of procedures for removal of acoustic tumors requires consideration of the patient’s neurological function and general condition, the topography of the tumor, and the surgeon’s expertise.