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A MAJOR principle of acoustic tumor surgery is the removal of the tumor without producing additional neurologic damage. This principle finds its ultimate application in the case of a small acoustic tumor confined to the internal auditory canal, typically arising from the vestibular division of the eighth nerve, and not yet large enough to have produced irreversible pressure damage to the cochlear division. This situation allows the surgeon to utilize a middle cranial fossa approach, thereby avoiding a labyrinthectomy and preserving, or even improving, hearing. Presumably all of our 200 cases of unilateral acoustic neuromas went through a stage in which they were small, produced minimal symptoms and physical findings are minithrough the middle fossa with preservation of hearing. There are, however, only five such cases in our entire series. It is apparent that this points out the very great need that we as diagnosticians become more suspicious of these
House et al. (Sun,) studied this question.