Facial Nerve Surgical Approaches

Surgical Approaches:

1. Retrosigmoidal=suboccipital
2. Retro-labyrinth
3. Translabyrinth
4. Trans-otic/trans cochlear
5. Middle cranial fossa approach
Retrolabyrinthine: brainstem + IAC

Translabyrinthine: THE WHOLE FACIAL NERVE (no limitation for tumor size)
Middle cranial fossa approach: Labyrinthine + genigulate ganglion + tympanic segment
 Anterior limit is the middle menigeal artery
 Lateral limit is bells bar
 identification of GSPN and arcuate eminence - IAC bisects angle formed by these two structures

Transmastoid approach:

 Disadvantage: limited access to the genigulate ganglion

Transmastoid middle cranial fossa translabyrinth

preserve hearing preserve hearing done in non serviceable
hearing
lesion distal/peripherial lesion medial to genigulate ganglion provide full exposure of
to genigulate ganglion sup view of labyrinthine + genigulate+ tympanic the intra-temporal and
lateral view of the segment brainstem portion of
tympanic and mastoid the facial nerve
segment