Interdural extra-arachnoidal resection of fifth nerve schwannomas with tailored petrous drilling: Eliminating the blind spot

Background and objectives Around 20-40% of trigeminal schwannomas (TS) are dumbbell shaped, spanning the middle and posterior cranial fossa The petrous apex is often truncated in these patients, aiding surgical resection of both compartments through the middle fossa approach. However, a less eroded petrous creates a blind spot, making total resection difficult. This study describes the feasibility of an approach combining expanded Meckel cave access with tailored petrous bone drilling to optimize tumor visualization and resection.