Which surgical approach sacrifices hearing during the dissection for vestibular schwannoma?

The trans-labyrinthine approach is utilized for the resection of vestibular schwannomas and is characterized by sacrificing hearing. This surgical technique involves accessing the cerebellopontine angle by removing the inner ear structures, which inevitably leads to loss of auditory function.

This approach is chosen primarily when the goal is to achieve maximal tumor removal, particularly when the tumor is large or when hearing preservation is not feasible due to the size or location of the tumor. By removing the structures of the inner ear, surgeons can gain direct access to the tumor while minimizing potential complications related to the surrounding neurovascular structures.

In contrast, other approaches like the middle fossa, retrosigmoid, and suboccipital can be employed with the potential of preserving hearing, depending on the specifics of the patient's tumor and anatomy. This differentiates the trans-labyrinthine approach from the alternatives, emphasizing its distinct characteristic of sacrificing hearing for surgical access and tumor removal.