Endoscopic-Assisted Keyhole Middle Cranial Fossa Approach for Small Vestibular Schwannomas

In Seok Moon, Ick Soo Choi, Seung Ho Shin, Seungjoon Yang, Youngrak Jung, Gina Na

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1 Scopus citations


The classical middle cranial fossa approach (MCFA) for vestibular schwannoma (VS) removal often requires a large incision and craniotomy, excessive temporal lobe manipulation, and a longer recovery. We describe a keyhole MCFA (KMCFA) with endoscopic assistance that allows for adequate access with minimal temporal lobe manipulation, resulting in a fast recovery and an invisible scar. Eight sides of four cadaveric heads were dissected through the endoscopic-assisted KMCFA to access the internal auditory canal (IAC). Furthermore, five patients with intracanalicular VS underwent tumor removal with the endoscopic-assisted KMCFA. During the endoscopic-assisted KMCFA with fine instruments, a 3-cm supra-auricular incision and a 2-cm diameter keyhole craniotomy achieved exposure of the entire length of the IAC in all cadaveric dissections without unintended violation of the cochlea, semicircular canal, and facial nerve. The gross tumor was totally removed in five patients with no major postoperative complications. The surgical time was reduced, the hearing outcomes were similar to those of the classical MCFA, and the scar was invisible 1 month after the surgery. The endoscopic-assisted KMCFA permits intracanalicular VS removal in a safe, efficient, and cosmetic way. For small intracanalicular VSs, this approach can replace the classical MCFA when indicated.

Original languageEnglish
Article number2324
JournalJournal of Clinical Medicine
Issue number9
StatePublished - 1 May 2022

Bibliographical note

Funding Information:
Funding: This research was supported by a grant from the Ministry of Health & Welfare (HI21C1574 to M.I.S.).

Publisher Copyright:
© 2022 by the authors. Licensee MDPI, Basel, Switzerland.


  • endoscope
  • middle cranial fossa
  • minimally invasive
  • vestibular schwannoma


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