The translabyrinthine approach is an option for removing a benign ear tumor called an acoustic neuroma or vestibular schwannoma. Surgeons make an incision behind the ear and remove bone from the inner ear to reach the tumor.

The translabyrinthine approach is one of several surgical options doctors may use to remove an acoustic neuroma. This benign tumor develops on the eighth cranial nerve, which travels from the inner ear to the brain.

Acoustic neuroma can cause various symptoms, including dizziness, tinnitus, and balance problems.

Doctors may consider the translabyrinthine approach for someone who already has hearing loss in the affected ear, as the procedure is hearing-destructive.

This article discusses why a person may require the translabyrinthine approach, what it involves, and the benefits and risks of the surgery. It also looks at the preparation, recovery, cost, and outlook for the procedure.

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The translabyrinthine approach is one of three main surgical options a doctor may use to remove a noncancerous tumor called an acoustic neuroma or vestibular schwannoma.

They may use the translabyrinthine surgical approach or one of the other main approaches, which are:

  • Retrosigmoid: This is where surgeons access the tumor through the base of the skull.
  • Middle cranial fossa: Surgeons access the tumor through an opening in the middle cranial fossa, which is in the middle of the cranium. The cranium is the part of the skull that houses the brain.

A surgeon may opt for the translabyrinthine approach if the tumor is large or the person has little or no hearing in the ear that contains the tumor.

Learn more about acoustic neuroma.

To remove an acoustic neuroma with the translabyrinthine approach, surgeons create an incision behind the ear. Surgeons remove the mastoid bone behind the ear and drill into the bone in the mastoid cavity. They then remove layers of bone until they reach the inner ear.

The surgeons remove portions of bone from the inner ear to expose the tumor.

Once they have exposed the acoustic neuroma and surrounding nerves, surgeons carefully remove the tumor, protecting the nearby nerves.

Every surgery has possible risks and benefits. A doctor will decide which approach is the most appropriate for an individual based on various factors.


In terms of benefits, the translabyrinthine approach:


Risks of the translabyrinthine approach include the potential for certain complications. Although uncommon, complications may include:

The translabyrinthine approach is hearing-destructive, which means the procedure results in hearing loss in the affected ear. People who are good candidates for this approach typically already have little to no hearing ability in the ear before they undergo surgery.

Before undergoing surgery to remove an acoustic neuroma, a person’s doctor may order tests, including a hearing test and imaging tests, such as MRI or CAT scans.

A person may need to stop taking certain medications before surgery to reduce the risks of bleeding. They may also need to stop eating and drinking for a period of time before surgery.

A person may also meet with their pre-op team, which may include an advanced practice registered nurse and anesthesiologist, to perform a physical examination and discuss anesthesia for the procedure.

Before surgery, a person can stock up on groceries and necessities ahead of time and arrange for someone to help with household chores and errands while they recover.

After surgery, a person may remain in hospital for 3–5 days. Healthcare professionals will monitor their recovery and administer pain medication. A doctor will prescribe pain medication to take at home.

A person may need to cover the wound for showering and avoid bathing, swimming, or hair treatments until the wound heals. A doctor may also advise them to avoid high intensity activity, bending at the waist, and heavy lifting during recovery.

Vestibular rehabilitation therapy and physical therapy may be necessary to help address symptoms a person may experience after surgery, such as balance issues and dizziness. Therapy may include exercises aimed at head movement, gaze stabilization, and balance.

During recovery, a person may experience swelling around the facial nerve. This may cause temporary facial paralysis, preventing the eye from closing fully. During this time, a person may require artificial tears to help prevent the eye from drying out.

People should contact their doctor if they notice fluid dripping from their nose, especially when bending over. This may indicate a cerebrospinal fluid leak.

The cost of surgery to remove acoustic neuromas may vary depending on factors such as the location of the surgical facility. Medicare may cover the cost.

A 2020 study calculated the mean operating room services cost of surgery to remove an acoustic neuroma as $68,417. The mean surgical supplies cost $5,028.

The outlook for the translabyrinthine approach is typically positive.

The approach has a tumor control rate of almost 95%. Tumor control refers to the destruction of tumor cells, which prevents them from being able to create clone cells and form growths.

Research has also found good outcomes for facial nerves in 85% of people and no mortality.

The translabyrinthine approach is a surgical technique in which surgeons make an incision behind the ear and remove bone to gain access to the skull base. Surgeons typically use this approach to remove acoustic neuromas, which are benign tumors in the inner ear.

A surgeon may opt for the translabyrinthine approach if a person already has hearing loss, as the technique results in hearing destruction. If the tumor is large, the approach is also beneficial as it provides suitable access to the relevant area of the skull.

A doctor will discuss the risks and benefits of different surgical approaches with each individual to determine the best possible option.