Surgery for a case of three-compartment trigeminal schwannoma : technical aspects

Complete removal of three-compartment trigeminal schwannomas is a challenge to neurosurgeons. To expand exposure of each compartment, the combination and modification of skull base approaches are necessary. The 61-year-old woman was admitted with chronic headache. Preoperative magnetic resonance imaging showed 47×50×40 mm-sized tumor originating primarily in the middle cranial fossa extended to the posterior and the infratemporal fossa. We performed operation in five stage; 1. Zygomatic osteotomy, 2. Inferior temporal fossa plate removal and foramen ovale opening, 3. Cavernous sinus opening, 4. Tailored anterior petrosectomy, 5. Meckel's cave opening. Combination of skull base surgery should be concerned according to the patient. In this study, extradural basal extension with zygomatic osteotomy, interdural posterior extension with tailored anterior petrosectomy, and intracavernous exploration are reasonable options for remodeling three-compartment lesion into a single compartment. Tailoring of bone resection and exploring through natural pathway between meningeal layers accomplish single-stage operation for complete removal of tumors.