• Xu Wang, Yuhai Bao, Ge Chen, Hongchuan Guo, Mingchu Li, Jiantao Liang, Xuesong Bai, and Feng Ling.
• Department of Skull Base Surgery Center, Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China.
• World Neurosurg. 2019 Jul 1; 127: e534-e541.

ObjectiveThe objectives of this study were to report 4 cases diagnosed with trigeminal schwannomas (TS), among whom tumor in epidural space of middle fossa broke through dura mater into subdural space, and to analyze the potential reason for recurrence of TS in middle fossa after surgical removal by endoscopic endonasal approach (EEA) or interdural approach.MethodsThe information of 4 patients diagnosed with TS who were surgically treated was retrospectively analyzed and the selection of approaches, surgical strategies, and potential reason for recurrence after middle fossa TS removal by EEA and interdural approach were discussed.ResultsDuring last 10 years, 43 patients with TS received surgical treatment at Xuan Wu Hospital of Capital Medical University, among whom 1 patient with TS extending from middle fossa to infratemporal fossa was first treated by EEA, then the tumor recurred and the patient underwent a second operation via a frontotemporal subdural approach. During the second operation, we found part of tumor had broken through the dura mater into subdural space. Moreover, this phenomenon was detected in another 3 patients with middle-posterior fossa TS.ConclusionsTS in middle fossa has been widely believed to be totally located at epidural space, whereas we found that it could occasionally breach into subdural space and accept blood supply from the pial artery. We believe this could be the potential reason for recurrence after tumor resection by EEA and interdural approach.Copyright © 2019. Published by Elsevier Inc.

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