{"id":"b5d28da9-9deb-4351-abf1-d8a46920a40f","slug":"endoscopic-lateral-transorbital-approach-for-resection-of-a-recurrent-trigeminal-schwannoma-two-dimensional-operative-video","title":"Endoscopic lateral transorbital approach for resection of a recurrent trigeminal schwannoma: Two-dimensional operative video","authors":["Juan Luis Gómez-Amador","Rodolfo Villalobos-Díaz","Edgardo de Jesús Mateo-Nouel","Luis Alberto Rodriguez-Hernandez","Marco Antonio Munuzuri-Camacho","Jesús Tomás Moncada-Habib","Alejandra Ahtziri Mendoza-Sandoval","Julio Enrique Cortes-Vargas","Gerardo Yoshiaki Guinto-Nishimura"],"abstract":"Background: Trigeminal schwannomas with middle and posterior fossa extension are difficult to treat, particularly after prior surgery or stereotactic radiosurgery (SRS). A minimally invasive interdural approach such as the endoscopic lateral transorbital approach (ELTOA) may offer safer access in these settings. Case description: We present the case of a 33-year-old woman with a history of partial resection of a left trigeminal schwannoma through a pterional approach and adjuvant SRS, who developed progressive left V1 paresthesia and trigeminal neuralgia. Neurological examination revealed hypoesthesia in V1-V2. Magnetic resonance imaging (MRI) demonstrated a dumbbell-shaped mass occupying the left middle cranial fossa, with a cystic component extending into the posterior fossa through Meckel’s cave, displacing the brainstem. Given symptom progression and mass effect, reoperation was indicated. An ELTOA, performed through a superior eyelid-crease incision, was selected to exploit a surgically naive interdural corridor parallel to the tumor axis, thereby minimizing brain retraction while providing direct access to Meckel’s cave and the posterior fossa. Postoperatively, the patient developed a transient cranial nerve IV palsy, her trigeminal neuralgia resolved, and she was discharged on postoperative day 5. Postoperative MRI demonstrated complete resection and decompression of the middle and posterior cranial fossae. Conclusion: This report demonstrates that the ELTOA is a feasible and safe reoperative strategy for trigeminal schwannomas in previously operated or irradiated corridors, reducing morbidity while achieving effective decompression. 00:04 – Case presentation 00-40 – Neuroimaging findings 01:01 – Rationale for the procedure 01:56 – Risks and benefits 02:38 – Alternative approaches 03:31 – Description of the setup 04:04 – Necessary equipment 04:33 – Key surgical steps 04:56 – Bony work for lateral transorbital approach 05:22 – Interdural peeling 05:37 – Tumoral resection 06:18 – Multilayer reconstruction 06:35 – Disease background 07:50 – Clinical outcome 08:12 – Imaging outcome Institutional review board approval is not required. The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. There are no conflicts of interest. The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI. The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/placeholders/specialty/skull-base.png","publishDate":"2026-03-20T00:00:00.000Z","doi":"10.25259/SNI_1327_2025","categories":["Skull Base","Video Abstract"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/b5d28da9-9deb-4351-abf1-d8a46920a40f/pdf"}