Arnold the Acoustic Neuroma: The Trans-what?-ian approach?

Warning: graphic surgical cartoons to follow!

Translabyrinthine Approach (Translab)

The below definition is from earsite.com as well as the images that follow:

The translabyrinthine approach is an approach that involves an incision behind the ear and a craniectomy (i.e. permanent removal of bone) of the mastoid bone and the semicircular canals of the inner ear. A consequence of this approach is the complete loss of hearing on the operated side. Tumors of all sizes can be visualized and removed using this approach. At the end of the operation, fat is harvested from the abdomen and used to replace the bone that was removed. This helps prevent the possibility of spinal fluid leakage.

This is from wikipedia:

The translabyrinthine approach was developed by William F. House, M.D., founder of the House Ear Institute [1], who began doing dissections in the laboratory with the aid of magnification and subsequently developed the first middle cranial fossa and then the translabyrinthine approach for the removal of acoustic neuroma.
This surgical approach is typically performed by a team of surgeons, including a neurotologist (an ear, nose, and throat surgeon specializing in skull base surgery) as well as a neurosurgeon.

And this article highlights the pros and cons well:

Pros: The one taught in medical schools, this surgical approach is preferred by many surgeons since it gives an excellent view of the tumor in the internal canal. Translab provides direct exposure of the tumor without the need to push aside any brain tissues to get at it. Translab makes it easiest to avoid the risk of facial nerve damage and facial paralysis (according to an article by a prominent neurosurgeon Dr. Brackmann, this is because translab permits positive identification of the facial nerve). Also, few muscles are attached to the mastoid so that there is little muscle pain after surgery. This surgical approach can be performed relatively quickly for small tumors.
Cons: Total deafness and loss of vestibular apparatus (balance organ) are guaranteed. The exposure is relatively small, so removal of large tumors may take longer and may be riskier. For such tumors, even when the facial nerve is preserved, there is a risk of a significant drop in the quality of life as a result of accidental damage to the brain.

I have compiled the words from earsite.com and Baylor College of Medicine. The Baylor site has actual surgical images; I find them too graphical and I can not really understand what I am looking at anyway.

Step 1 to 3 can take up to 3 hours to perform. That part is done by the ENT, in my case Dr. L from UCSF. The resection of the tumor itself it done by a neurologist, Dr. M from UCSF will be doing that part.

Step 1: A translabyrinthine approach to excision of an acoustic neuroma is illustrated. An incision is made behind the ear.

Step 2: The mastoid bone and surrounding muscles are exposed

The mastoid bone has been exposed and partially drilled out. Water is constantly flushed over the drill tip to keep it cool, and bone chips, etc., are suctioned away from the site. Various sizes and types of drill bits are used, including diamond bits. The temporal bone contains some of the densest bone in the body, and has to be drilled away very carefully.

Step 3: A mastoidectomy is performed exposing the semicircular canals, venus sinus, dura covering the brain, and spinal fluid. The semicircular canals are removed exposing the internal auditory canal.

Step 4: The tumor is exposed and the dura of the internal auditory canal is opened.

The vestibular nerve is cut with precision surgical scissors in order to get to the tumor. A small "cottonoid" which is used to absorb liquids in the area and increase visibility.

Step 5: The tumor can be seen extending into the internal auditory canal. The trigeminal nerve that is responsible for transmitting information on facial sensation is displaced. The central portion of the tumor is gutted out allowing the capsule to collapse on itself.

Tumor which is remote from the facial nerve is cauterized and removed bit by bit.

Step 6: The capsule is then dissected away from the facial nerve.