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We originally described the transcranial translabyrinthine approach (TCTL) to acoustic neuroma. The approach is a labyrinthine dissection that is performed via the suboccipital exposure. It allows a complete and direct visualization of the internal auditory canal and the identification of the facial nerve at “Bill's bar.” The TCTL enhances the suboccipital approach and adapts to its concepts of the classical transmastoid translabyrinthine approach. We hereby report our initial experience with the TCTL and present the surgical results in six additional cases. We also discuss the indications of this approach and compare it to alternative approaches that are used for the removal of large acoustic neuromas that extend laterally in the internal auditory canal.