• Bharath Raju, Fareed Jumah, Purvee Patel, and Anil Nanda.
• Department of Neurosurgery, Rutgers-Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA.
• Neurol India. 2020 Sep 1; 68 (5): 1016-1018.

Background And IntroductionDumbbell trigeminal schwannoma is the second most common type of intracranial schwannomas.ObjectiveHerein, we are describing and presenting a video of left trigeminal dumbbell schwannoma with a predominant posterior fossa component (modified Samii's grade C1), operated through left Retromastoid Intradural Suprameatal Approach (RISA). We demonstrate a step by step technique of a previously defined procedure for educational purpose.Surgical TechniqueThe patient was placed in the right lateral position, and left retromastoid craniotomy was done. Dura was opened based on transverse and sigmoid sinus to expose tumors in the suprameatal region. The tumor removed piecemeal under the microscope, and later endoscope was introduced to identify and remove the residual tumor in the superolateral part of Meckel's cave.ResultsThe patient had an uneventful recovery.ConclusionTrigeminal schwannoma with a predominantly posterior fossa component can be excised through retromastoid sub-occipital craniotomy. Endoscopic-assisted microsurgery should be considered in all skull base tumors. Aim for complete excision, but safe maximal resection with GKRS for residual can be considered in difficult cases.

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