{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T01:23:25Z","timestamp":1755221005616,"version":"3.43.0"},"reference-count":8,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\nBackground: <\/jats:title>\nSurgical management of cerebellopontine angle (CPA) lesions remains challenging due to the region\u2019s complex anatomy. The microscopic anterior transpetrosal approach or combined petrosectomy is the standard technique for trigeminal schwannomas and CPA meningiomas, but requires extensive craniotomy and dissection. For smaller tumors, the endoscopic anterior transpetrosal approach (eATPA) offers a less invasive alternative, providing access to the petrous apex and Meckel cave with minimal temporal lobe retraction. This report presents the initial experience in Indonesia utilizing the keyhole eATPA technique, assessing feasibility, safety, and outcomes.<\/jats:p>\n<\/jats:sec>\n\nCase Description: <\/jats:title>\nIn 2024, three patients with ~2 cm CPA lesions compressing the trigeminal nerve\u2013one trigeminal schwannoma and two CPA meningiomas\u2013underwent eATPA using a pure endoscopic four-hands technique. The procedure included a 3 cm subtemporal craniotomy, intradural identification of the Greater Superficial Petrosal Nerve with intraoperative monitoring, drilling of Kawase triangle, opening of Meckel cave, tumor resection, and trigeminal nerve decompression. Total resection and successful decompression were achieved in all cases. Trigeminal neuralgia improved: The two CPA meningioma patients experienced complete pain relief, while the schwannoma patient had residual facial numbness. Operative time was 4\u20135 h due to the learning curve, with minimal bleeding, no cerebrospinal fluid leakage, and no new neurological deficits. Patients reported mild incisional pain and were discharged within 3 days. At 3\u20136 months\u2019 follow-up, all remained clinically stable.<\/jats:p>\n<\/jats:sec>\n\nConclusion: <\/jats:title>\nThis early experience suggests the keyhole eATPA technique is a feasible, safe, and effective approach for small CPA lesions, offering favorable clinical outcomes and faster post-operative recovery.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_552_2025","type":"journal-article","created":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T06:59:53Z","timestamp":1754636393000},"page":"330","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Endoscopic subtemporal keyhole anterior transpetrosal approach in small cerebellopontine angle tumors with trigeminal neuralgia: A case series of three patients"],"prefix":"10.25259","volume":"16","author":[{"given":"Donny Wisnu","family":"Wardhana","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Universitas Brawijaya \/ Dr. Saiful Anwar General Hospital, Malang, East Java, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farhad","family":"Balafif","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Universitas Brawijaya \/ Dr. Saiful Anwar General Hospital, Malang, East Java, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tommy Alfandy","family":"Nazwar","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Universitas Brawijaya \/ Dr. Saiful Anwar General Hospital, Malang, East Java, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fachriy","family":"Balafif","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Universitas Brawijaya \/ Dr. Saiful Anwar General Hospital, Malang, East Java, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anisa Nur","family":"Kholipah","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Universitas Brawijaya \/ Dr. Saiful Anwar General Hospital, Malang, East Java, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroki","family":"Morisako","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeo","family":"Goto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2025,8,8]]},"reference":[{"key":"10.25259\/SNI_552_2025\/ref-1","article-title":"Cerebellopontine angle cancer","volume-title":"StatPearls","author":"Lak","year":"2025"},{"key":"10.25259\/SNI_552_2025\/ref-2","doi-asserted-by":"crossref","first-page":"e256","DOI":"10.1097\/SCS.0000000000003481","article-title":"Symptomatic trigeminal neuralgia caused by cerebellopontine angle tumors","volume":"28","author":"Liu","year":"2017","journal-title":"J Craniofac Surg"},{"key":"10.25259\/SNI_552_2025\/ref-3","first-page":"20","article-title":"Trigeminal neuralgia caused by cerebellopontine angle tumors: Surgical series","volume":"38","author":"Meguins","year":"2019","journal-title":"Brazil Neurosurg"},{"key":"10.25259\/SNI_552_2025\/ref-4","doi-asserted-by":"crossref","first-page":"752","DOI":"10.3171\/2024.1.JNS231774","article-title":"Purely endoscopic subtemporal keyhole anterior transpetrosal approach to access the petrous apex region: Surgical techniques and early results","volume":"141","author":"Morisako","year":"2024","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_552_2025\/ref-5","doi-asserted-by":"crossref","first-page":"249","DOI":"10.4103\/njms.NJMS_2_19","article-title":"Trigeminal neuralgia secondary to cerebellopontine angle tumor: A case report and brief overview","volume":"10","author":"Prakash","year":"2019","journal-title":"Natl J Maxillofac Surg"},{"key":"10.25259\/SNI_552_2025\/ref-6","first-page":"1","article-title":"Purely endoscopic subtemporal keyhole approach for trigeminal schwannomas: Surgical techniques and early results","volume":"10","author":"Sasaki","year":"2024","journal-title":"Oper Neurosurg (Hagerstown)"},{"key":"10.25259\/SNI_552_2025\/ref-7","doi-asserted-by":"crossref","first-page":"108","DOI":"10.3171\/2023.11.JNS231532","article-title":"Anterior transpetrosal approach and the tumor removal rate, postoperative neurological changes, and complications: Experience in 274 cases over 33 years","volume":"141","author":"Tomio","year":"2024","journal-title":"J 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