Combined Transcavernous and Anterior Petrosectomy [Kawase] Approach to a Trigeminal Schwannoma: 2-Dimensional Operative Video

Trigeminal schwannomas are benign tumors arising from Schwann cells and account for 0.07% to 0.3% of all intracranial neoplasms.1 They can originate anywhere along the trigeminal nerve (cisternal segment, gasserian ganglion, or 1 of 3 peripheral branches of the trigeminal nerve).1 Several classification systems have been proposed for classification of trigeminal schwannomas based on the location of origin and extension into adjacent regions.2-7 The classification of these lesions can help in selection of the optimal surgical approach.8 We present the case of a 25-year-old man with blurry vision, headaches, diplopia with left lateral gaze, and left V2-3 hypoesthesia Imaging revealed a 5.1 × 3.8 × 3.7-cm dumbbellshaped left trigeminal schwannoma in the middle and posterior fossae The patient underwent a combined left transcavernous and anterior petrosectomy (Kawase) approach Postoperatively, the patient developed newleft V1 hypoesthesia At the 8-month follow-up, partial left cranial nerve 6 palsy and left V3 hypoesthesia resolved, but the patient continued to have left V1 and V2 hypoesthesia Postoperative imaging revealed radical subtotal resection The case presentation, surgical anatomy, operative technique, and postoperative course and outcomes were reviewed We demonstrate the step-by-step surgical technique of a combined transcavernous and anterior petrosectomy approach, tumor resection, and the review and summary of known classification schemes for trigeminal schwannomas The patient consented to the procedure and participation in the publication of this surgical video Content at 7:42 republished from Jefferson G,2 by permission of the Congress of Neurological Surgeons Content at 7:52 republished from Day and Fukushima,3 by permission of the Congress of Neurological Surgeons Content at 8:02 republished from Dolenc VV,4 by permission from Springer Nature.