The translabyrinthine approach is the most direct route to the cerebellopontine angle. It is the preferred approach for removal of all tumors in patients with poor hearing and for large tumors when the likelihood of hearing preservation is slight. This approach offers the advantages of minimum cerebellar retraction, identification of the facial nerve proximally and medially, and the ability to repair immediately the facial nerve if it is severed during acoustic tumor removal. This approach has the lowest morbidity with regard to spinal fluid leaks and also postoperative headaches.