Object The authors provide a detailed review of the surgical management of trigeminal schwannomas (TSs) and also discuss the best surgical approach based on the surgical anatomy and tumor extension. Methods A series of 17 patients with TSs who were surgically treated between 1987 and 2008 at the authors' institution is reported. The lesions were small (< 3 cm) in 2, medium (between 3 and 4 cm) in 5, large (> 4 cm) in 6, and giant (> 5 cm) in 4 cases. Preoperative symptoms included trigeminal hypesthesia (53%), facial pain (53%), headaches (35.3%), hearing impairment (17.6%), seizures (17.6%), diplopia (11.8%), ataxia (11.8%), and hemiparesis and increased intracranial pressure with papilledema (5.9%). The mean follow-up duration was 10.5 years (121.6 months), with an average of 0.8 patients per year. Results Total tumor excision was possible in 16 patients, with no surgery-related deaths. Postoperative trigeminal anesthesia was observed in 7; trigeminal motor function was preserved in 7. Two developed cerebrospinal fluid leakage, 2 presented with mild facial palsy, and 1 patient with neurofibromatosis Type 2 had recurrence of the tumor, which was uneventfully removed. Of the 9 who reported facial pain, only 1 remained symptomatic postoperatively. Conclusions The best treatment for TSs is complete microsurgical removal. Postoperative preservation of trigeminal nerve function is possible when resection of the lesion is performed at well-established skull base neurosurgical centers. Although good results have been reported with radiosurgery, no cure can be obtained with this therapeutic modality. Instead, this treatment should be reserved only for nonresectable and residual tumors within the cavernous sinus.

-We report our experience with a supraorbital eyebrow minicraniotomy. This technique is suitable to lesions situated in the region of the anterior fossa, suprasellar cisterns, parasellar region and Sylvian fissure. A 50 mm incision in the eyebrow and a supraorbital minicraniotomy is performed. Sixteem patients harboring different lesions were operated on with good postoperative and cosmetic results. We conclude that this approach is safe and useful in selected cases.KEY WORDS: tumor, aneurysm, skull base, minimally invasive, surgical approach.Abordagem supra-orbitária superciliar de lesões da base do crânio RESUMO -Reportamos nossa experiência com o uso de uma minicraniotomia supra-orbitária através do supercílio para tratamento de lesões situadas na fossa anterior, cisterna supra-selar, para-selar e fissura de Sylvius. Uma incisão de 50 mm é realizada no supercílio, seguida de minicraniotomia. Dezesseis pacientes portadores de diferentes lesões foram operados e apresentaram bom resultado pós-operatório e também estético. Concluímos que esse acesso é seguro e útil em casos selecionados PALAVRAS-CHAVE: tumor, aneurisma, base do crânio, abordagem minimamente invasiva, acesso cirúrgico. Usually tumors, aneurysms, and other lesions situated in the anterior or middle cranial fossae are approached by the standard classic pterional craniotomy [1][2][3] . Some other new techniques are also used to approach the orbit, anterior fossa and skull base 4-9 .Recently Perneczky et al. [10][11][12] have developed several supraorbital endoscopic "key-hole" approaches and demonstrated a good visualization of the socalled "suprasellar virtual pyramid". Combination of endoscopy and microneurosurgery permits the reduction of the size of the craniotomy required for good visualization of tumor or aneurysm and surrounding structures if compared to traditional techniques. We report our experience with a supraorbital eyebrow approach. We add to the description of our 16 cases some details on important landmarks. These landmarks are useful to preserve the frontotemporal branch of the facial nerve, the supraorbital and supratrochlear nerves in order to prevent cosmetic sequela of this easy and time-sparing procedure.

Primary meningiomas of the jugular foramen are extremely rare. There is controversy regarding the management of these tumors. The objective of this article is to analyze the treatment and results in a series of ten cases. From a series of 107 patients that had been operated on for jugular foramen tumors between 1987 and 2005, ten had meningiomas. The clinical, histological and imaging findings, as well as the outcome of these cases, were reviewed. A high incidence of malignant or aggressive tumors (six cases) was found. Gross total resection (Simpson I and II) was achieved in five patients. Four patients with meningotheliomatous meningiomas are alive, with a mean follow-up time of 71.8 months (6.5 years). Two patients (one with anaplastic type and one with papillary type) died in the immediate postoperative period. Four patients (two with papillary type, one with microcystic type and one with anaplastic type) died because of disease progression, with a mean survival time of 35 months. Radical removal of benign jugular foramen meningiomas is possible. The incidence of postoperative deficit of cranial nerves is higher than in other benign tumors of the jugular foramen. A high incidence of aggressive (malignant) tumors was observed in this series.

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