Preservation of hearing was attempted in 161 cases of histologically confirmed acoustic neuroma removed by the senior author between January 1, 1970, and September 30, 1991. There were 136 patients with unilateral tumors; 22 patients had bilateral tumors (neurofibromatosis 2) and underwent a total of 25 procedures. Hearing was initially preserved in 35% of patients with unilateral tumors and in 44% of those with bilateral tumors. Results are reported in terms of pre- and postoperative pure tone average and speech discrimination scores. Surgical access to the tumor was obtained via middle cranial fossa and suboccipital approaches. The latter has been used more often over the past 5 years because of a lower associated incidence of transient facial paresis. Persistent postoperative headaches have been the most common complication following the suboccipital approach. The results of preoperative brain-stem auditory evoked response (BAER) studies were useful in predicting the outcome of hearing preservation attempts. Patients with intact BAER waveform morphology and normal or delayed latencies had a higher probability of hearing preservation in comparison to those with abnormal preoperative BAER morphology.

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As a discipline, skull-base surgery via the transtemporal route has matured since 1975. Previously considered unresectable, skull-base tumors with intracranial extension can now be successfully removed by means of modification of contemporary exposures with neurosurgical collaboration. Between September 1970 and February 1986, 126 skull-base tumors have been operated on by The Otology Group, P.C. Of these, 49 had intracranial extension. In this article, techniques for tumor removal and dural defect reconstruction are outlined. A single-staged procedure is advised. The advantages of and exceptions to this format are described. Techniques that will prevent postoperative cerebrospinal fluid leakage are highlighted. Results and complications of this surgical series are discussed, and team aspects of this surgery are emphasized.

This paper reviews 180 cerebellopontine angle lesions in regard to results and complications of the surgical management with special emphasis on the diagnosis, surgical removal, and results in 60 large (4 cm. or greater) tumors of the CPA. The authors conclude that in their experience a one-stage combined translabyrinthine-suboccipital approach, which is explained in detail, is the procedure of choice in dealing with large tumors of the CPA.

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