Selecting a surgical approach for removal of acoustic Schwannoma

The removal of acoustic Schwannomas has presented a most difficult problem in treatment since the early years of this century. The evolution of treatment modes and subsequent treatment goals is briefly discussed. The three major approaches to the affected region are reviewed: the posterior fossa, translabyrinthine, and middle fossa approaches. Each approach is evaluated in the contexts of advantages to prognosis, preservation of anatomy and function of hearing, and special technical problems presented. The selection of approach should be made on an individual basis, using the best available means of identifying the position and extent of the given tumor. Descriptions of commonly encountered situations are included. The goals of each procedure should be both the successful and total removal of tumor and the preservation of the functions of hearing and of the cranial nerves and vascular structures affected by surgery.