Pretemporal anteromedial interdural approach to Meckel's cave: How I do it.

Abstract

The pretemporal anteromedial interdural approach provides direct extradural access to Meckel's cave by exploiting the natural plane between the temporal dura propria and the meningeal layer of the lateral wall of the cavernous sinus. After a pretemporal craniotomy, the foramen rotundum guides interdural dissection along V2 toward the corridor between V1 and V2, enabling controlled exposure of the Gasserian ganglion and proximal trigeminal rootlets. Tumor resection proceeds through internal debulking and circumferential dissection, with extension into the posterior fossa when necessary. In this How I Do It article, we present the key technical steps of the pretemporal anteromedial interdural approach to Meckel's cave, emphasizing anatomical landmarks and operative nuances. This approach allows safe and effective removal of trigeminal schwannomas while limiting cavernous sinus manipulation and reducing morbidity.