{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T23:43:47Z","timestamp":1791330227482,"version":"4.3.1"},"reference-count":54,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2012,9]]},"abstract":"\n Object<\/jats:title>\n In the early 1960s William F. House developed the middle fossa approach for the removal of small vestibular schwannomas (VSs) with the preservation of hearing. It is the best approach for tumors that extend laterally to the fundus of the internal auditory canal, although it does have the potential disadvantage of increased facial nerve manipulation, especially for tumors arising from the inferior vestibular nerve. The aim of this study was to monitor the hearing preservation and facial nerve outcomes of this approach.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A prospective database was constructed, and data were retrospectively reviewed.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Between December 2004 and January 2012, 30 patients with small VSs underwent surgery via a middle fossa approach for hearing preservation. The patients consisted of 13 men and 17 women with a mean age of 46 years. Tumor size ranged from 7 to 19 mm. Gross-total resection was accomplished in 25 of 30 patients. Preoperative hearing was American Academy of Otolaryngology\u2013Head and Neck Surgery (AAO-HNS) Class A in 21 patients, Class B in 5, Class C in 3, and undocumented in 1. Postoperatively, hearing was graded as AAO-HNS Class A in 15 patients, Class B in 7, Class C in 1, Class D in 2, and undocumented in 5. Facial nerve function was House-Brackmann (HB) Grade I in all patients preoperatively. Postoperatively, facial nerve function was HB Grade I in 28 patients, Grade III in 1, and Grade IV in 1. There were 3 complications: CSF leakage in 1 patient, superficial wound infection in 1, and extradural hematoma (asymptomatic) in 1. The overall hearing preservation rate of at least 73% and HB Grade I facial nerve outcome of 93% in this cohort are in keeping with other contemporary reports.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The middle fossa approach for the resection of small VSs with hearing preservation is a viable and relatively safe option. It should be considered among the various options available for the management of small, growing VSs.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2012.7.focus12172","type":"journal-article","created":{"date-parts":[[2012,9,1]],"date-time":"2012-09-01T12:14:35Z","timestamp":1346501675000},"page":"E10","source":"Crossref","is-referenced-by-count":30,"title":["Hearing preservation surgery for vestibular schwannoma: experience with the middle fossa approach"],"prefix":"10.3171","volume":"33","author":[{"given":"Franco","family":"DeMonte","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul W.","family":"Gidley","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0330010","series-title":"Otol Neurotol","first-page":"234","article-title":"Hearing preservation and facial nerve outcomes in vestibular schwannoma surgery: results using the middle cranial fossa approach","volume":"27","author":"Arts","year":"2006"},{"key":"b2-0330010","series-title":"J Neurosurg","first-page":"662","article-title":"Conservative management of 386 cases of unilateral vestibular schwannoma: tumor growth and consequences for treatment. Clinical article","volume":"110","author":"Bakkouri","year":"2009"},{"key":"b3-0330010","series-title":"Int J Radiat Oncol Biol Phys","first-page":"845","article-title":"Long-term follow-up of acoustic schwannoma radiosurgery with marginal tumor doses of 12 to 13 Gy","volume":"68","author":"Chopra","year":"2007"},{"key":"b4-0330010","series-title":"Otolaryngol Head Neck Surg","first-page":"179","article-title":"Guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma)","volume":"113","author":"Committee on Hearing and Equilibrium","year":"1995"},{"issue":"Suppl 17","key":"b5-0330010","series-title":"B-ENT","first-page":"77","article-title":"Hearing outcome after gamma knife radiosurgery for vestibular schwannoma: a prospective Belgian clinical study","volume":"7","author":"Delbrouck","year":"2011"},{"key":"b6-0330010","series-title":"J Neurosurg","first-page":"855","article-title":"Prospective comparison of quality of life before and after observation, radiation, or surgery for vestibular schwannomas. Clinical article","volume":"111","author":"Di Maio","year":"2009"},{"issue":"6","key":"b7-0330010","series-title":"Neurosurg Focus","first-page":"E3","article-title":"Evaluation of hearing function after Gamma Knife surgery of vestibular schwannomas","volume":"27","author":"Franzin","year":"2009"},{"key":"b8-0330010","series-title":"Otolaryngol Head Neck Surg","first-page":"660","article-title":"Long-term hearing preservation after middle fossa removal of vestibular schwannoma","volume":"129","author":"Friedman","year":"2003"},{"key":"b9-0330010","series-title":"J Neurosurg","first-page":"1078","article-title":"Factors associated with hearing preservation after Gamma Knife surgery for vestibular schwannomas in patients who retain serviceable hearing. Clinical article","volume":"115","author":"Hasegawa","year":"2011"},{"key":"b10-0330010","series-title":"Otolaryngol Head Neck Surg","first-page":"115","article-title":"Facial nerve function and hearing preservation acoustic tumor surgery: does the approach matter?","volume":"142","author":"Hillman","year":"2010"},{"key":"b11-0330010","series-title":"Otol Neurotol","first-page":"132","article-title":"Late failure rate of hearing preservation after middle fossa approach for resection of vestibular schwannoma","volume":"32","author":"Hilton","year":"2011"},{"key":"b12-0330010","series-title":"Arch Otolaryngol","first-page":"460","article-title":"Middle cranial fossa approach to the petrous pyramid. Report of 50 cases","volume":"78","author":"House","year":"1963"},{"key":"b13-0330010","series-title":"Laryngoscope","first-page":"1363","article-title":"Surgical exposure of the internal auditory canal and its contents through the middle, cranial fossa","volume":"71","author":"House","year":"1961"},{"key":"b14-0330010","series-title":"Arch Otolaryngol","first-page":"631","article-title":"Middle cranial fossa approach to acoustic tumor surgery","volume":"88","author":"House","year":"1968"},{"key":"b15-0330010","series-title":"Laryngoscope","first-page":"2087","article-title":"Nerve of origin, tumor size, hearing preservation, and facial nerve outcomes in 359 vestibular schwannoma resections at a tertiary care academic center","volume":"117","author":"Jacob","year":"2007"},{"key":"b16-0330010","series-title":"Neurosurgery","first-page":"334","article-title":"Hearing preservation using the middle fossa approach for the treatment of vestibular schwannoma","volume":"70","author":"Kutz","year":"2012"},{"key":"b17-0330010","series-title":"Otol Neurotol","first-page":"380","article-title":"Small acoustic neuromas: surgical outcomes versus observation or radiation","volume":"27","author":"Meyer","year":"2006"},{"key":"b18-0330010","series-title":"Neurosurgery","first-page":"1054","article-title":"Hearing preservation after intracanalicular vestibular schwannoma radiosurgery","volume":"63","author":"Niranjan","year":"2008"},{"key":"b19-0330010","series-title":"Otol Neurotol","first-page":"1463","article-title":"Predictive factors of hearing preservation after surgical resection of small vestibular schwannomas","volume":"31","author":"Phillips","year":"2010"},{"key":"b20-0330010","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1352","article-title":"Stereotactic radiosurgery for acoustic neuromas: what happens long term?","volume":"82","author":"Roos","year":"2012"},{"key":"b21-0330010","series-title":"Neurosurgery","first-page":"640","article-title":"Critical assessment of operative approaches for hearing preservation in small acoustic neuroma surgery: retrosigmoid vs middle fossa approach","volume":"67","author":"Sameshima","year":"2010"},{"key":"b22-0330010","series-title":"Laryngoscope","first-page":"1500","article-title":"Risk-benefit analysis of using the middle fossa approach for acoustic neuromas with > 10 mm cerebellopontine angle component","volume":"112","author":"Satar","year":"2002"},{"key":"b23-0330010","series-title":"J Laryngol Otol","first-page":"490","article-title":"Hearing outcomes of vestibular schwannoma patients managed with \u2018wait and scan\u2019: predictive value of hearing level at diagnosis","volume":"124","author":"Stangerup","year":"2010"},{"key":"b24-0330010","series-title":"J Clin Neurosci","first-page":"1126","article-title":"Hearing preservation rates after microsurgical resection of vestibular schwannoma","volume":"17","author":"Sughrue","year":"2010"},{"key":"b25-0330010","series-title":"Surg Neurol","first-page":"586","article-title":"Middle fossa approach: microsurgical anatomy and surgical technique from the neurosurgical perspective","volume":"71","author":"Tanriover","year":"2009"},{"key":"b26-0330010","series-title":"Otol Neurotol","first-page":"1144","article-title":"Long-term hearing preservation after microsurgical excision of vestibular schwannoma","volume":"31","author":"Woodson","year":"2010"},{"key":"b27-0330010","series-title":"J Neurosurg","first-page":"851","article-title":"A comprehensive analysis of hearing preservation after radiosurgery for vestibular schwannoma. Clinical article","volume":"112","author":"Yang","year":"2010"},{"key":"b1-0330010","series-title":"Otol Neurotol","first-page":"234","article-title":"Hearing preservation and facial nerve outcomes in vestibular schwannoma surgery: results using the middle cranial fossa approach","volume":"27","author":"Arts","year":"2006"},{"key":"b2-0330010","series-title":"J Neurosurg","first-page":"662","article-title":"Conservative management of 386 cases of unilateral vestibular schwannoma: tumor growth and consequences for treatment. Clinical article","volume":"110","author":"Bakkouri","year":"2009"},{"key":"b3-0330010","series-title":"Int J Radiat Oncol Biol Phys","first-page":"845","article-title":"Long-term follow-up of acoustic schwannoma radiosurgery with marginal tumor doses of 12 to 13 Gy","volume":"68","author":"Chopra","year":"2007"},{"key":"b4-0330010","series-title":"Otolaryngol Head Neck Surg","first-page":"179","article-title":"Guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma)","volume":"113","author":"Committee on Hearing and Equilibrium","year":"1995"},{"issue":"Suppl 17","key":"b5-0330010","series-title":"B-ENT","first-page":"77","article-title":"Hearing outcome after gamma knife radiosurgery for vestibular schwannoma: a prospective Belgian clinical study","volume":"7","author":"Delbrouck","year":"2011"},{"key":"b6-0330010","series-title":"J Neurosurg","first-page":"855","article-title":"Prospective comparison of quality of life before and after observation, radiation, or surgery for vestibular schwannomas. Clinical article","volume":"111","author":"Di Maio","year":"2009"},{"issue":"6","key":"b7-0330010","series-title":"Neurosurg Focus","first-page":"E3","article-title":"Evaluation of hearing function after Gamma Knife surgery of vestibular schwannomas","volume":"27","author":"Franzin","year":"2009"},{"key":"b8-0330010","series-title":"Otolaryngol Head Neck Surg","first-page":"660","article-title":"Long-term hearing preservation after middle fossa removal of vestibular schwannoma","volume":"129","author":"Friedman","year":"2003"},{"key":"b9-0330010","series-title":"J Neurosurg","first-page":"1078","article-title":"Factors associated with hearing preservation after Gamma Knife surgery for vestibular schwannomas in patients who retain serviceable hearing. Clinical article","volume":"115","author":"Hasegawa","year":"2011"},{"key":"b10-0330010","series-title":"Otolaryngol Head Neck Surg","first-page":"115","article-title":"Facial nerve function and hearing preservation acoustic tumor surgery: does the approach matter?","volume":"142","author":"Hillman","year":"2010"},{"key":"b11-0330010","series-title":"Otol Neurotol","first-page":"132","article-title":"Late failure rate of hearing preservation after middle fossa approach for resection of vestibular schwannoma","volume":"32","author":"Hilton","year":"2011"},{"key":"b12-0330010","series-title":"Arch Otolaryngol","first-page":"460","article-title":"Middle cranial fossa approach to the petrous pyramid. Report of 50 cases","volume":"78","author":"House","year":"1963"},{"key":"b13-0330010","series-title":"Laryngoscope","first-page":"1363","article-title":"Surgical exposure of the internal auditory canal and its contents through the middle, cranial fossa","volume":"71","author":"House","year":"1961"},{"key":"b14-0330010","series-title":"Arch Otolaryngol","first-page":"631","article-title":"Middle cranial fossa approach to acoustic tumor surgery","volume":"88","author":"House","year":"1968"},{"key":"b15-0330010","series-title":"Laryngoscope","first-page":"2087","article-title":"Nerve of origin, tumor size, hearing preservation, and facial nerve outcomes in 359 vestibular schwannoma resections at a tertiary care academic center","volume":"117","author":"Jacob","year":"2007"},{"key":"b16-0330010","series-title":"Neurosurgery","first-page":"334","article-title":"Hearing preservation using the middle fossa approach for the treatment of vestibular schwannoma","volume":"70","author":"Kutz","year":"2012"},{"key":"b17-0330010","series-title":"Otol Neurotol","first-page":"380","article-title":"Small acoustic neuromas: surgical outcomes versus observation or radiation","volume":"27","author":"Meyer","year":"2006"},{"key":"b18-0330010","series-title":"Neurosurgery","first-page":"1054","article-title":"Hearing preservation after intracanalicular vestibular schwannoma radiosurgery","volume":"63","author":"Niranjan","year":"2008"},{"key":"b19-0330010","series-title":"Otol Neurotol","first-page":"1463","article-title":"Predictive factors of hearing preservation after surgical resection of small vestibular schwannomas","volume":"31","author":"Phillips","year":"2010"},{"key":"b20-0330010","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1352","article-title":"Stereotactic radiosurgery for acoustic neuromas: what happens long term?","volume":"82","author":"Roos","year":"2012"},{"key":"b21-0330010","series-title":"Neurosurgery","first-page":"640","article-title":"Critical assessment of operative approaches for hearing preservation in small acoustic neuroma surgery: retrosigmoid vs middle fossa approach","volume":"67","author":"Sameshima","year":"2010"},{"key":"b22-0330010","series-title":"Laryngoscope","first-page":"1500","article-title":"Risk-benefit analysis of using the middle fossa approach for acoustic neuromas with > 10 mm cerebellopontine angle component","volume":"112","author":"Satar","year":"2002"},{"key":"b23-0330010","series-title":"J Laryngol Otol","first-page":"490","article-title":"Hearing outcomes of vestibular schwannoma patients managed with \u2018wait and scan\u2019: predictive value of hearing level at diagnosis","volume":"124","author":"Stangerup","year":"2010"},{"key":"b24-0330010","series-title":"J Clin Neurosci","first-page":"1126","article-title":"Hearing preservation rates after microsurgical resection of vestibular schwannoma","volume":"17","author":"Sughrue","year":"2010"},{"key":"b25-0330010","series-title":"Surg Neurol","first-page":"586","article-title":"Middle fossa approach: microsurgical anatomy and surgical technique from the neurosurgical perspective","volume":"71","author":"Tanriover","year":"2009"},{"key":"b26-0330010","series-title":"Otol Neurotol","first-page":"1144","article-title":"Long-term hearing preservation after microsurgical excision of vestibular schwannoma","volume":"31","author":"Woodson","year":"2010"},{"key":"b27-0330010","series-title":"J Neurosurg","first-page":"851","article-title":"A comprehensive analysis of hearing preservation after radiosurgery for vestibular schwannoma. 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