The surgical management issues of 157 cases of trigeminal neurinoma treated over a 20-year period were analyzed. The case records and radiologic material of these patients who were operated on in the Neurosurgery Department at King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, between the year 1989 and 2009 were retrospectively analyzed. The appropriateness of the selected surgical route is studied. Apart from the other typical presenting features of trigeminal schwannoma, 12 patients presented with the rarely reported symptom of pathologic laughter. Three approaches were found appropriate to treat these tumors: the infratemporal fossa interdural approach, the lateral and anterior basal subtemporal approach, and the retrosigmoid approach. For tumors extending extracranially, a ‘reverse skull base approach’ that involved basal temporal craniotomy was used. In 129 (82%) cases, total tumor excision was achieved. Two patients died during the postoperative period. During an average follow-up of 52 months, there has been a recurrence in 5 cases. Radical surgery is associated with an excellent clinical outcome and long-term tumor control. A majority of tumors, even those that are large and multicompartmental, can be removed in a single surgical stage and exposure.

Key Words: gasserian ganglion, retrosigmoid approach, subtemporal approach, trigeminal neurinoma