Translabyrinthine approach

The translabyrinthine approach is a surgical approach to the cerebellopontine angle, or CPA. It is used in the surgical extirpation of lesions of the cerebellopontine angle, including acoustic neuroma.

The translabyrinthine approach was developed by William F. House, M.D., founder of the House Ear Institute , who began doing dissections in the laboratory with the aid of magnification and subsequently developed the first middle cranial fossa 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 neurosurgeon.

In this approach, the semicircular canals and vestibule, including the utricle and the saccule of the inner ear 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 persevered in a higher percentage of cases than 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%.