Translabyrinthine Approach

Abstract

The translabyrinthine approach gives access to the internal auditory canal (IAC) through mastoidectomy and drilling of semicircular canals and vestibule. Due to iatrogenic damage to the membranous labyrinth, postoperative hearing loss is expected so that this approach is best indicated for preoperatively already deaf patients. Advocates of this approach cite early identification of the facial nerve in the IAC and minimal brain or cerebellar retraction, which allows for removal of vestibular schwannomas of any size. The patient is placed in lateral or supine position. A postauricular C-shaped incision is made, 2 cm behind the postauricular crease. Fukushima’s outer mastoid triangle is exposed, and the cortex over the mastoid bone is removed. Mastoidectomy is performed in successive steps in order to expose the semicircular canals, which are drilled to gain access into the IAC.