Extended frontotemporal craniotomy with orbitozygomatic glenoid fossa osteotomy for resection of giant trigeminal schwannoma: illustrative case.

backgroundSkull base lesions, including tumors of the petroclival region and brainstem, can be challenging. Surgical access to these regions is associated with significant morbidity due to their deep location and proximity to critical structures. These lesions include meningiomas, chordomas, basilar trunk aneurysms, epidermoid tumors, and schwannomas, all of which often cause mass effect with significant symptoms and thus require surgical intervention. The authors describe a corridor for safe access to maximize the preservation of essential functions while improving access without associated morbidity. OBSERVATIONS: Here, the authors describe an extended frontotemporal craniotomy combined with an orbitozygomatic glenoid fossa osteotomy to access and safely resect a giant trigeminal schwannoma. This surgical technique allowed for enhanced exposure of the lesion while reducing the surgical distance and the need for excessive subtemporal retraction, which can otherwise contribute to postoperative complications. Importantly, the procedure allowed for the long-term preservation of temporomandibular joint (TMJ) function, which is crucial for maintaining normal jaw movement and quality of life. LESSONS: The incorporation of a glenoid fossa osteotomy in the surgical approach reduced the working distance to the lesion and improved intraoperative visibility, thus minimizing retraction-related injury, allowing for safe resection and preservation of the TMJ. https://thejns.org/doi/10.3171/CASE25178.