The retrolabyrinthine (RLB) approach, first described in the 1970s, has been largely forgotten due to its technical complexity and longer operative time. Despite this, it remains the only extradural route that allows access to internal auditory canal (IAC) without compressing the brain or cerebellum, while aiming to preserve hearing. Its versatility and safety are often underestimated.
Neurotologists and skull-base surgeons may find this anatomical study and literature review useful for reconsidering the retrolabyrinthine approach for select cases; no change to audiological (non-surgical) practice is indicated.
Rehabilitating an underutilised, hearing-preserving surgical corridor may offer neurotologists a valuable alternative to more destructive approaches for specific skull-base and posterior fossa pathologies.
- 01The retrolabyrinthine approach preserves hearing by avoiding the cochlea and semicircular canals during skull-base surgery.
- 02First described in the 1970s, the technique has been largely underutilised despite its potential advantages.
- 03Anatomical cadaveric or imaging study maps surgical landmarks and indications.
- 04Literature review consolidates evidence on outcomes and case selection for the approach.
- 05Primarily relevant to neurotology and skull-base surgery subspecialists rather than general audiologists.
The retrolabyrinthine approach is versatile and underutilised relative to its potential surgical indications.
studypartially supported- PMID
- 42378549
- DOI
- 10.5152/iao.2025.252097.
- Journal
- Journal of the International Advanced Otology
- Publication type
- review
- Evidence level
- 4
- Population
- Anatomical specimens or imaging data; surgical cases drawn from literature review
- Intervention
- Retrolabyrinthine surgical approach
Primary outcomes
Anatomical landmarks and feasibility of the retrolabyrinthine approach; Clinical indications identified via literature review; Surgical outcomes associated with the retrolabyrinthine technique