I've done my 'homework'. I've researched all the research. In the weeks leading up to my surgery, I felt I had known all I needed to know. It was then that I made my final decision.
Translabyrinthine
The oldest surgical approach is translabryinthine. This procedure provides the best line of sight of the facial nerve and consequently offers the highest success rate of facial nerve preservation for a patient. The downside is that this procedure sacrifices an individual's hearing. It should only be selected when a person has severe hearing loss or the tumor is too large for hearing preservation surgery. Translab is the preferred surgical choice by most doctors when the hearing level is no longer useable. It is also a good choice when a tumor is above 20 mm as, statistically, facial nerve damage increases with large tumors.
The entry is behind the ear in which the mastoid bone and some bone in the inner ear is removed.
Middle fossa
This approach will be used to attempt hearing preservation. Statistics show that the better the hearing one has ahead of the operation the better the chances of good hearing preservation. The location of the tumor on the superior nerve vs. the inferior nerve is better. The HEI website states that "In patients with small tumors who have been operated by the middle fossa approach since 1992., good hearing has been preserved in roughly two thirds of those patients. Any measurable level of hearing was preserved in 80%." It has higher hearing preservation rates for tumors under 2 cm than retrosigmoid. From the HEI website, it states that: "95% of 380 patients undergoing MF maintained excellent facial nerve function. Only five percent suffered minor weakness of facial nerve function."
The incision is made in front of the ear by creating a bone flap. There is an unobstructed view of the entire IAC with this surgical approach. This allows complete tumor removal. The middle fossa approach is performed by lifting of the temporal lobe of the brain. This approach is not recommended for patients above 60.
Retrosigmoid (suboccipital)
This approach is used to attempt hearing preservation. Success rates vary from 30-65% in CPA tumors smaller than 1.5 cm with good hearing and limited involvement of the IAC. However a tumor extending to the fundus is a contraindication to the RS approach for hearing preservation. The tumor removal is accomplished with mirrors.
