The Sunnybrook Facial Grading System (eFACE) and FNGS 2.0 have been developed as improvements over House-Brackmann. However, for small acoustic neuroma surgery (<1.5 cm), the recommended management option that BEST preserves hearing is:
- A Translabyrinthine approach (TL)
- B Retrosigmoid / suboccipital approach (RS)
- C Middle cranial fossa approach (MCF) ✓
- D Stereotactic radiosurgery (Gamma Knife) in all cases
Explanation
For small intracanalicular acoustic neuromas with serviceable hearing, the middle cranial fossa (MCF) approach provides the best access to the internal auditory canal while preserving the cochlea. It is preferred for small (<1.5 cm) tumours confined to the IAC with good preoperative hearing. The translabyrinthine approach sacrifices hearing but offers good facial nerve exposure for larger tumours. Retrosigmoid approach can preserve hearing for small to medium tumours at the porus but is less ideal for purely intracanalicular tumours. Gamma Knife is a valid option for tumours <3 cm with serviceable hearing where surgery is refused or patient is unfit.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.