Advances in Removal of Acoustic Neuromas: The Suboccipital Approach

EVOLUTION of the surgical management of acoustic neuromas during the first half of this century culminated in the consensus that a total removal is preferable to a subtotal removal, and that preservation of the facial nerve is an extravagance if it forces a subtotal removal. Horrax, 1 in 1950, reported a representative experience. He cited a 56% five-year mortality and 25% useful survival for Cushing's series of subtotal removals, as compared to his own 14% five-year mortality and 62% useful survival for a series with total removals. Techniques and attitudes remained fixed over the next decade. Kurze and Doyle, 2 and House, 3 shared early experiences with a microsurgical approach to the internal auditory canal through a middle fossa approach. Seeking a more commodious approach, Rand and Kurze 4 developed the posterior fossa transmeatal microdissection technique, opening the posterior wall of the internal auditory canal through the conventional suboccipital approach.