Minipterional Approach for Middle Fossa Skull Base Lesions: Technical Note

Area of Science:

• Neurosurgery
• Minimally Invasive Techniques
• Cranial Base Surgery

Background:

• Surgical access to the middle fossa presents significant technical challenges.
• The evolution towards minimally invasive neurosurgical approaches necessitates refined surgical techniques.
• Trigeminal neuralgia, particularly secondary forms, often requires complex surgical intervention.

Purpose of the Study:

• To demonstrate the extension of the Minipterional approach for middle fossa access.
• To present a novel surgical strategy for treating secondary trigeminal neuralgia.
• To evaluate the feasibility and efficacy of the Minipterional approach in complex neurosurgical cases.

Main Methods:

• Presentation of three case studies utilizing the extended Minipterional approach.
• Surgical intervention for petrotentorial meningioma with trigeminal neuralgia.
• Management of an arachnoid cyst compressing the trigeminal nerve.
• Treatment of a middle cerebral artery aneurysm associated with refractory trigeminal neuralgia.

Main Results:

• All three patients achieved complete symptom control of trigeminal neuralgia.
• No permanent neurological deficits were observed post-operatively.
• The Minipterional approach facilitated simultaneous treatment of trigeminal neuralgia and associated lesions (meningioma, aneurysm).

Conclusions:

• The Minipterional technique is a feasible, effective, and safe option for refractory secondary trigeminal neuralgia.
• This approach is valuable when the posterior fossa approach is compromised by anatomical distortion.
• It allows for the simultaneous management of secondary trigeminal neuralgia and other cranial base pathologies.