Infratemporal fossa interdural approach for trigeminal neurinomas.

A small craniectomy in the infratemporal fossa incorporating the foramen ovale was used to resect 4 large trigeminal neurinomas. The tumour extended from the posterior cranial fossa and involved Meckel's cave and the lateral wall of the cavernous sinus in each instance. The dural sheath around the mandibular nerve and Gasserian ganglion was opened to expose the entire lesion. The head position and the surgeon's view of the tumour were modified to obtained a basal view. The craniectomy at this strategic site provided an avenue for control of the carotid artery at the petrous apex, avoided the need for brain retraction and permitted safe and complete resection of the tumours. The approach appears to be ideal for selected cases of trigeminal neurinomas.