In this approach, bone is removed above the ear to expose the top of the inner ear and internal auditory canal. Following removal of the roof of the canal, access to the tumor is gained. This method is reserved for small tumors with good residual hearing that is worth trying to preserve

In this approach, the bone directly behind the ear (mastoid bone) is removed to expose the inner ear structures which are also removed. The internal auditory canal is exposed along its entire length and is then opened to remove the tumor. By removing the inner ear, all residual hearing is lost and thus this approach is used when the hearing loss is already severe or if hearing preservation is not a realistic goal.

In this approach, bone behind the mastoid and inner ear is removed to expose the tumor and the posterior aspect of the internal auditory canal. The back wall of the canal is removed to allow access to this portion of the tumor. This method can allow for hearing preservation in certain cases and may be used for small and large tumors