To introduce a purely endoscopic endonasal trans-Meckel's cave approach or a transclival approach for trigeminal schwannomas (TSs) involving both the middle and posterior fossae. This retrospective study reviewed the medical records and intraoperative videos of 8 patients with TSs occupying both the middle and posterior fossae who underwent an endoscopic endonasal approach (EEA) between January 2017 and October 2019. All 8 patients received total resection under a single-stage EEA. Six patients underwent endoscopic endonasal resection via a purely trans-Meckel's cave approach, and 2 patients underwent endoscopic endonasal resection via a trans-Meckel's cave approach combined with a transclival approach. There was no surgical-related hemorrhage or mortality and no cerebrospinal fluid leakage. All headache symptoms completely improved postoperatively (n = 3 patients). All cranial nerve (CN) symptoms (CN IX and CN VI) improved postoperatively. The most common preoperative symptom was facial numbness (n = 5 patients); 2 of these 5 patients showed a partial improvement, 1 patient experienced worsening, and 2 patients remained unchanged at the last follow-up. Four patients developed postoperative complications, including CN VI palsy (n = 2), dry eye (n = 2), mastication weakness (n = 1), and facial numbness (n = 2). All complications except for dry eye were relieved at the last follow-up, but the patients with dry eye did not develop corneal keratopathy. The endoscopic endonasal trans-Meckel's cave and transclival approaches provide adequate exposure and improve the rate of total resection for TSs occupying both the middle and posterior fossae with minimal invasion. It may be possible to use these approaches as a safe alternative to conventional surgical approaches.

中文翻译：

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单阶段内窥镜鼻腔入路可完全清除占据中，后窝的三叉神经鞘瘤。

引入纯内窥镜鼻内鼻-Meckel's穴入法或经三叉神经鞘瘤（TSs）的跨斜入路，涉及中，后窝。这项回顾性研究回顾了2017年1月至2019年10月期间接受内镜鼻内入路（EEA）的8例同时位于中，后颅窝的TS患者的病历和术中视频。所有8例患者均在单阶段EEA下接受了全切除术。6例患者通过单纯的经Meckel's穴入路行鼻内镜下鼻腔切除术，2例患者通过经Trans-Meckel's穴入法结合经腹腔镜行鼻内镜切除术。没有手术相关的出血或死亡，也没有脑脊液漏出。术后所有头痛症状均得到完全改善（n = 3例）。术后所有颅神经（CN）症状（CN IX和CN VI）均得到改善。术前最常见的症状是面部麻木（n = 5例）。这5例患者中有2例显示部分改善，1例恶化，2例在最后一次随访中保持不变。4名患者发生了术后并发症，包括CN VI麻痹（n = 2），干眼症（n = 2），咀嚼无力（n = 1）和面部麻木（n = 2）。在最后一次随访中，除干眼症外所有并发症均得到缓解，但干眼症患者未发生角膜角化病。内窥镜鼻内Meckel' 塌陷和经跨步入路可为侵占中，后颅窝的TS提供充分的暴露并提高总切除率，且侵袭最小。可以将这些方法用作常规手术方法的安全替代方法。