Objectives: To analyze the surgical management of six trigeminal neurinomas and the different approaches performed by our neurosurgery and maxillofacial team.
Material and methods: We present six cases of trigeminal neurinoma with a massive involvement of the skull base. The tumours presented extension to the infratemporal fossa and the masticatory space. All cases presented invasion of the cavernous sinus. One case demonstrated an invasion of the infratemporal fossa, another the posterior fossa and one case growed along the third trigeminal branch to the lower lip.
Discussion: The surgical approach was a facial translocation in four cases and a preauricular-subtemporal approach in two cases. Mandibular osteotomies were performed in five cases. The skull base defect was reconstructed in four cases with a temporalis muscle flap and in two cases with a rectus abdominis myocutaneous microvascular flap. All cases had a total tumour excision. Only two complications were observed: eyelid retraction and facial paresis. After a postoperative follow-up of 10 years, any tumoural recurrences were observed (0%). One patient died of malignant transformation to neurosarcoma.
Conclusions: Radical surgery is associated with an excellent clinical outcome and a good long-term tumour control.