A patient with a 3 cm acoustic neuroma (VS) and serviceable hearing (AAO-HNS Class A/B) on the affected side requests hearing preservation surgery. Which surgical approach provides the best chance of hearing preservation?

• A Retrosigmoid (suboccipital) approach ✓
• B Translabyrinthine approach
• C Middle cranial fossa (MCF) approach
• D Infralabyrinthine approach

Explanation

For larger tumors (>2 cm) with serviceable hearing where preservation is the goal, the retrosigmoid (suboccipital) approach offers the best chance of hearing preservation as it does not sacrifice the labyrinth. The middle fossa approach is preferred for small intracanalicular or medially confined tumors with serviceable hearing. The translabyrinthine approach sacrifices the cochlea and provides no hearing preservation. For 3 cm tumors, middle fossa is technically challenging, making retrosigmoid the preferred hearing-preservation approach.

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.