[Neurinoma of the trigeminal nerve. Excision by combined suboccipital and pteriono-temporal approach].

The authors report a recent personal case of trigeminal neurinoma with a topographical extension both in the cerebello pontine angle and the middle cerebral fossa. This 33 year-old female suffered from progressive sensory disturbances of her right hemiface associated with a right fifth nerve motor deficit, a right VI nerve palsy and a tinnitus. CT scan and angiogram were evocative of a right hourglass trigeminal neurinoma. Two successive operative stage through suboccipital route and a pteriono-temporal extra and intradural approach allowed a complete removal of the tumour. A post-operative rhinorrhea dried up with 10 days. The patient complained with a right hemiface anesthesia and a palsy of the masseter muscles; the VI nerve palsy recovered within 3 months. From the review of the literature (118 cases) the authors summarize the anatomical, clinical and radiological features of these tumours and point out. The difficulty of their surgical removal that was only complete in half of cases. The high frequency of hourglass neurinomas explains that a single suboccipital or subtemporal approach--even with opening of the tentorium--only allowed 23 complete removal among the 58 published or quoted interventions. This justifies that in a majority of cases a combined approach must be preferred, using successively a suboccipital and an intradural subtemporal route, the latted giving access to the cavernous sinus in case of its invasion.