Skull Base Surgery of the Posterior Fossa

© Springer International Publishing AG 2018 37
W.T. Couldwell (ed.), Skull Base Surgery of the Posterior Fossa,
https://doi.org/10.1007/978-3-319-67038-6_3

Middle Fossa

and Translabyrinthine Approaches

Justin C. Sowder, Breanne L. Schiffer,

Richard K. Gurgel, and Clough Shelton

J.C. Sowder, MD • B.L. Schiffer, MD, MPH
R.K. Gurgel, MD • C. Shelton, MD (*)
Division of Otolaryngology – Head and Neck
Surgery, University of Utah School of Medicine,
50 N. Medical Dr. SOM 3C120, Salt Lake City,
UT 84113, USA
e-mail: [email protected]; Breanne.
[email protected]; [email protected];
[email protected]

3

Abbreviations

AAO-HNS American Academy of
Otolaryngology-Head and Neck
Surgery
ABR Auditory brainstem response
CPA Cerebellopontine angle
dB Decibel
DVT Pulmonary embolism
EAC External auditory canal
GSPN Greater superficial petrosal nerve
GTR Gross-total resection
HB House-Brackmann
IAC Internal auditory canal
ICH Intracerebral hemorrhage
MRI Magnetic resonance imaging
NTR Near-total resection
PE Pulmonary embolism
POD Postoperative day
PTA Pure-tone average

SDS Speech discrimination score

SNHL Sensorineural hearing loss

SRT Speech reception threshold

STR Subtotal resection

Introduction

Surgical approaches to the internal auditory

canal (IAC) and cerebellopontine angle (CPA)

for the treatment of acoustic neuromas have

improved dramatically since their inception.

While early surgical techniques were used pri-

marily for debulking of large tumors and reliev-

ing pressure on the brainstem, modern skull

base surgery has evolved to focus more on

functional preservation, particularly with

regard to serviceable hearing and facial nerve

function.

The middle fossa approach is an example of a

surgical approach to the skull base that was devel-

oped to preserve function. The middle fossa

approach was originally reported in 1904 to gain

access for vestibular nerve sectioning. This was

prior to the introduction of the operating micro-

scope and modern microsurgical techniques, and

the facial nerve was at high risk for injury during

these procedures [ 1 ]. The approach was further

developed when William F. House revised it in

1961. Through cadaver studies, it was realized that