Pretemporal anteromedial interdural approach to Meckel's cave: How I do it

Area of Science:

• Neurosurgery
• Surgical Anatomy

Background:

• Meckel's cave is a critical neurosurgical region housing the trigeminal nerve.
• Trigeminal schwannomas often require surgical intervention for effective treatment.
• Direct extradural access to Meckel's cave is essential for safe tumor resection.

Purpose of the Study:

• To describe the pretemporal anteromedial interdural approach for accessing Meckel's cave.
• To highlight the technical nuances and anatomical landmarks of this surgical technique.

Main Methods:

• The approach involves a pretemporal craniotomy to access the interdural space.
• Dissection proceeds along the trigeminal nerve (V2) towards the Gasserian ganglion.
• Tumor resection is performed via internal debulking and circumferential dissection.

Main Results:

• This approach provides direct extradural access to Meckel's cave.
• It allows for controlled exposure of the Gasserian ganglion and trigeminal rootlets.
• Tumor resection can be extended into the posterior fossa if necessary.

Conclusions:

• The pretemporal anteromedial interdural approach enables safe and effective trigeminal schwannoma removal.
• This technique limits manipulation of the cavernous sinus.
• It is associated with reduced surgical morbidity.