FRONTOTEMPORAL EPIDURAL APPROACH TO TRIGEMINAL NEURINOMAS

From 1980 through 1993 an series of 44 patients with trigeminal neurin omas were treated. Five of them were operated on for the remainder of the tumour as they had undergone previous surgery elsewhere, 35 were o perated on for the first time, and 4 were not operated on for various reasons. An epidural approach to the neurinomas originating in the bra nches of the Vth nerve peripheraly to the Gasserian ganglion (GG) was used. In the neurinomas originating in the GG or in the root of the Vt h nerve, either an epidural-transdural approach or an epidural-transdu ral-transpetrous approach was used. All tumours operated on using the approach described in this article were completely removed. In 10 pati ents, the Vth nerve sensory deficits increased in comparison with preo perative deficits; in 9 their state remained unaltered; and in 11 the sensory function of the Vth nerve improved. In those patients who had experienced pre-operative atypical trigeminal pain, the pain disappear ed after surgery. There was no additional treatment: radiosurgery, irr adiation or chemotherapy. Histopathological examination did not reveal any malignant changes in the tumours in any of the patients. Based on our own experience and on the published data it is believed that the best treatment for trigeminal neurinomas is complete microsurgical rem oval of the lesion.