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Ege Üniversitesi Tıp Fakültesi KBB Hastalıkları Anabilim Dalı, İzmir Middle fossa approach for vestibular nerve zone was first reported around 1904. During this period surgical hammer and chisel were used for surgical exposure, and could lead to damage to the facial nerve. William House performed and offered middle fossa surgery for advanced osteosclerosis in 1961. After William House introduced this middle fossa approach to the vestibular zone, many surgeons started to use this technique. Acouple of years later, this approach was abandoned by the surgeons, because a couple of years later, of some complications such as facial nerve injury. But in the era of modern imaging techniques such as gadolinium enhanced MRI, middle fossa approach was adopted for acoustic neuroma surgery. The first years of the middle fossa approach to the acoustic neuroma, the procedure was performed without making selection between acoustic neuroma cases, but later it has been demonstrated that middle fossa approach has been more beneficial for small tumours, beacuse of better preservation of the facial and vestibular nerve function than big tumours. Using of the gadolinium enhanced MRI studies could lead to early diagnosis of the acoustic neuromas and with early diagnosis of this tumour, patients can be diagnosed before their loss of hearing function. Increased number of patient diagnosed with small acoustic neuroma and preserved hearing function compels surgeons to perform more middle fossa surgery than the pre-MRI epoch. Anahtar Kelimeler : Acoustic neuroma, Surgery, Middle fossa