The translabyrinthine approach is a surgical approach to treating serious disorders of the

cerebellopontine angle The cerebellopontine angle (CPA) ( la, angulus cerebellopontinus) is located between the cerebellum and the pons. The cerebellopontine angle is the site of the cerebellopontine angle cistern one of the subarachnoid cisterns that contains cerebro ...

, (CPA), which is the most common location of posterior fossa tumors. especially

acoustic neuroma A vestibular schwannoma (VS), also called acoustic neuroma, is a benign tumor that develops on the vestibulocochlear nerve that passes from the inner ear to the brain. The tumor originates when Schwann cells that form the insulating myelin sheath o ...

. In this approach, the

semicircular canals The semicircular canals or semicircular ducts are three semicircular, interconnected tubes located in the innermost part of each ear, the inner ear. The three canals are the horizontal, superior and posterior semicircular canals. Structure The ...

and vestibule, including the utricle and the

saccule The saccule is a bed of sensory cells in the inner ear. It translates head movements into neural impulses for the brain to interpret. The saccule detects linear accelerations and head tilts in the vertical plane. When the head moves verticall ...

of the

inner ear The inner ear (internal ear, auris interna) is the innermost part of the vertebrate ear. In vertebrates, the inner ear is mainly responsible for sound detection and balance. In mammals, it consists of the bony labyrinth, a hollow cavity in the ...

are removed, causing complete hearing loss in the operated ear. The procedure is typically performed by a team of surgeons, including a neurotologist (an ear, nose, and throat surgeon specializing in skull base surgery) as well as a

neurosurgeon Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and peri ...

Background

The translabyrinthine approach was developed by William F. House, M.D., who began doing dissections in the laboratory with the aid of magnification and subsequently developed the first

middle cranial fossa The middle cranial fossa, deeper than the anterior cranial fossa, is narrow medially and widens laterally to the sides of the skull. It is separated from the posterior fossa by the clivus and the petrous crest. It is bounded in front by the pos ...

and then the translabyrinthine approach for the removal of acoustic neuroma. This surgical approach is typically performed by a team of surgeons, including a neurotologist (an ear, nose, and throat surgeon specializing in skull base surgery) as well as a

. In this approach, the

and vestibule, including the utricle and the

of the

are removed with a surgical drill, causing complete sensorineural hearing loss in the operated ear. The facial nerve, which innervates the muscles of the face, is preserved in a higher percentage of cases than with other approaches. Prior to the translabyrinthine approach, in the early 1960s acoustic neuromas were treated utilizing a suboccipital approach without the aid of an operating microscope. With the introduction of the translabyrinthine approach, mortality rates decreased from 40% in the State of California to 1%.

References

{{reflist Neurosurgery