This is a patient-to-patient account of the translabyrinthine approach. I am not a medical professional. I am sharing my experience and understanding in the hope that it helps others who are facing the same road.
When I first saw the name, I could not even pronounce it — translabyrinthine. I still struggle to. It sounded like something out of a medical textbook, not a word that would suddenly become a part of my life. But there it was, in the middle of a sentence spoken by my surgeon, calmly explaining how they planned to reach the tumour in my brain.
As with everything I write here, I share what I have been through and what I have learned because I believe a little understanding helps you make sense of things. Especially when those things are overwhelming, frightening, and life-changing.
When I was told I needed brain surgery to remove my acoustic neuroma, I was not given a menu of options. My doctors told me plainly: “This is the best possible approach for your case.” And I trusted them. My tumour was large — 4.7 cm — and the translabyrinthine approach was the only viable path forward. Fourteen hours later, I came out of surgery with a sliver of tumour left behind (just 16 mm) to preserve my facial nerve. Today I want to focus on something many newly diagnosed patients ask:
What exactly is the translabyrinthine approach?
Why do surgeons choose it?
And how does it work?
Let us break it down together.
What Is the Translabyrinthine Approach?
The word “translabyrinthine” might sound intimidating, but it simply means “going through the labyrinth,” which is the name for the complex inner ear system that handles both hearing and balance. In this approach, the surgeon accesses the acoustic neuroma by drilling through the inner ear structures behind the affected ear.
This route provides a direct path to the tumour without needing to manipulate the brain. But it comes with a trade-off: the hearing in that ear is completely sacrificed. For many of us with large tumours, that hearing is already gone or severely diminished, so this is not as devastating as it might sound. In my case, I had already come to terms with single-sided deafness before even entering the operating theatre.
This approach also removes part of the balance system on that side, but the brain often compensates with time. More importantly, this method offers the clearest and safest view of the tumour and surrounding nerves — especially the facial nerve, which is vital for expressions, blinking, and mouth movement.
Why Is It Preferred for Large Tumours?
If your tumour is large or growing close to the brainstem, the translabyrinthine approach is often the go-to surgical method. Here is why:
- Early and clear identification of the facial nerve: This is one of the key benefits. Surgeons are able to see and protect the facial nerve from the very beginning of the procedure. In large tumours, preserving this nerve is often the top priority.
- No brain retraction needed: Unlike some other surgical methods, the translabyrinthine approach does not require the surgeon to move or compress parts of the brain to access the tumour. This reduces the risk of damage to healthy brain tissue.
- Better access for complete tumour removal: When the tumour fills the internal auditory canal and presses into the cerebellopontine angle (the area near the brainstem), this method gives surgeons the best chance of removing as much tumour as possible, while still being safe.
It is worth noting that the surgical mindset has evolved. In the past, the goal was often to remove the entire tumour at all costs. Today, the focus has shifted: preserving facial nerve function is just as important as removing the tumour. Surgeons now use advanced facial nerve monitoring throughout the procedure. Electrodes track the nerve in real time, so if the instruments come close or the nerve is under stress, the team is alerted immediately. The priority is clear — you do not want to wake up with a droopy face. Sometimes, as in my case, a small portion of the tumour is deliberately left behind to protect the nerve. It is a calculated and compassionate choice.
How Is It Done?
This is a high-precision surgery that typically involves two specialists: a neurotologist (ear and skull base surgeon) and a neurosurgeon. Here is a simplified overview of how it is done:
- Incision and exposure: A curved incision is made behind the ear, and the skin and tissue are gently moved aside. The surgeon then removes part of the mastoid bone and drills through the inner ear (the labyrinth) to create a corridor toward the tumour.
- Sacrificing the inner ear: The hearing and balance organs on the tumour side are removed. This gives direct access to the internal auditory canal and the space between the brainstem and cerebellum where the tumour often grows.
- Tumour identification and removal: Using high-powered microscopes and monitoring systems, the surgeons locate the tumour and facial nerve. Removal is done slowly and carefully, sometimes millimetre by millimetre. Facial nerve monitoring is used throughout to avoid damage.
- Closure: After the tumour is removed (or reduced as much as safely possible), the surgical space is filled with a small amount of fat (usually from the abdomen) to help prevent fluid leaks. The area is closed, and the patient is moved to recovery.
It sounds intense — and it is. But for large tumours where hearing is already compromised, this approach is a well-established, widely used, and often life-saving technique.
Final Thoughts
If you are newly diagnosed and your doctor mentions the translabyrinthine approach, I know how overwhelming it can be. Just hearing the word “tumour” is enough to send anyone into a spiral. But know this: the approach is chosen with safety, visibility, and facial nerve preservation in mind.
Yes, it means hearing loss on one side. But it also means a clearer path to the tumour, less risk to your brain, and a better chance of protecting your ability to smile, speak, and blink.
I did not get to choose my approach, and honestly, I am glad I did not have to. My medical team knew what they were doing, and their decision gave me the best possible outcome given the size and location of my tumour.
If you are facing this kind of surgery, take heart: you are not the first to walk this path, and there is a community here that understands. I will keep sharing more around acoustic neuroma. My whole website is dedicated to it, as I could not write everything in my memoir Whispers Through the Fog.
Stay informed. Stay hopeful. You have got this.
Thank you very much for eloquently describing this approach. It is very important to have a simple guide like this, as information is usually scattered and overwhelming.