Trigeminal schwannomas are rare, benign tumors with diverse extension patterns along the trigeminal nerve, which significantly influence surgical approach selection. This article presents strategies for selecting optimal approaches based on tumor location, classified into middle, posterior, and extracranial compartments. Commonly used approaches include the anterior transpetrosal, epidural and interdural approaches, and recently introduced minimally invasive techniques, such as the endoscopic endonasal transmaxillary-pterygoid and transorbital approaches. The anatomical accessibility, safety, and feasibility of each technique are discussed. A detailed understanding of the trigeminal nerve's membranous anatomy, including the inner reticular layer and Meckel's cave, enables subcapsular dissection while preserving functional neural structures. This article describes practical techniques, including multilayer skull base reconstruction, venous preservation modifications, and intraoperative neurophysiological monitoring, to mitigate complications, such as venous injury, cerebrospinal fluid leakage, and cranial nerve dysfunction. Additionally, it offers a comprehensive overview of the decision-making and technical nuances essential for safe and effective resection of trigeminal schwannomas in complex skull base regions.
Shunsuke Shibao (Tue,) studied this question.