Combined Petrosal Approach for Resection of a Large Trigeminal Schwannoma With Meckel's Cave Involvement-Part II: Microsurgical Approach and Tumor Resection: 2-Dimensional Operative Video.

This video is the second part of a 2-part video presentation demonstrating the microsurgical technique of a combined petrosal approach for resection of a large trigeminal schwannoma in a 54-yr-old woman involving multiple cranial fossae extending anteriorly into Meckel's cave. The patient presented with long-standing worsening headache and facial tingling and numbness. After discussing the benefits and risks of the surgery as well as the alternative management strategies, the patient decided to proceed with surgery and informed consent was obtained. The surgery was performed in a single stage. The technical nuances of anterior and posterior (retrolabyrinthine) petrosectomy are demonstrated and discussed. Microsurgical resection of the tumor is also demonstrated emphasizing the important steps of dural opening, arachnoid dissection, identification and preservation of cranial nerves, and exploration of Meckel's cave. Use of endoscopic-assistance for visualization of the cerebellopontine angle and neurovascular structures is also demonstrated.  Table in video reprinted by permission from Copyright Clearance Center: Springer Nature, Acta Neurochirurgica, Frontotemporal epidural approach to trigeminal neurinomas, Dolenc VV, Copyright 1994.