Value of Anterior Petrosectomy During an Interdural, Trans-Meckel’s Cave Approach to Dumbbell-Shaped Trigeminal Schwannoma

Abstract: A detailed understanding of the dural anatomy of the trigeminal nerve, particularly the Meckel’s cave, and the petrous apex is essential to accomplish an interdural approach in dumbbell-shaped trigeminal schwannomas (TSs) from the middle fossa side. A 34-year-old gentleman with left hemifacial pain and masseter weakness on examination was found to have a dumbbell-shaped TS around the petrous apex occupying the adjacent middle cranial fossa, posterior fossa, and the cavernous sinus. We performed an extended middle fossa approach (EMFA), taking an interdural route, and with the addition of an extradural anterior petrosectomy (AP), the tumor was completely resected. Postoperative imaging revealed a complete tumor excision, and the patient has been doing well at follow-up examinations. An EMFA with tailored AP provides an excellent control of the posterior fossa component of TS due to improved angulation and blind spot visualization.