Trigeminal nerve sheath tumors are the most common intracranial non-vestibular nerve sheath tumors, accounting for 0.8-8% of all intracranial nerve sheath tumors. 1-year postoperative mortality rate for trigeminal nerve sheath tumors was as high as 41% in 1956, but with improved surgical techniques, advances in neuroimaging, intraoperative electrophysiological monitoring, and modern microsurgical techniques, the surgical mortality rate has decreased significantly, but complete removal of trigeminal nerve However, with improved surgical techniques, neuroimaging, intraoperative electrophysiological monitoring and modern microsurgical techniques, the surgical mortality rate has decreased significantly. The most difficult tumor is the dumbbell tumor, which is located in the middle and posterior cranial fossa across the apical part of the skull and develops both intracranially and extracranially, making it difficult to remove completely during surgery and the recurrence rate is high after surgery. The application of modern endoscopic techniques has brought the light for complete resection of dumbbell-shaped trigeminal nerve sheath tumors. Recently Professor Samii et al. used endoscopic techniques during resection of trigeminal nerve sheath tumors. The study included 20 patients with trigeminal nerve sheath tumors who underwent surgery at the International Institute of Neuroscience in Hannover, Germany, between 2001 and 2013. Six of the patients were seen for recurrence after the first subtotal resection, with a mean follow-up time of 28.5 months. According to Smaii tumor staging, C1 type accounted for 8 cases, A2 type 5 cases, D2 type 3 cases, A3 type 2 cases, and A1 and B type 1 case each. The mean tumor size was 35.6 mm. 14 patients had solid tumors, 1 had cystic, and 5 had mixed tumors. The most common preoperative clinical symptom was facial sensory allergy. Complete resection was achieved in 15 patients, and near-total resection was achieved in 5 patients. The reasons for incomplete resection included limited visual field and tight adhesions of the tumor to the surrounding tissue, which often occurred after radiation therapy. No serious postoperative complications were observed in all patients, and transient neurological decline was seen in three patients. Postoperatively, all patients showed significant improvement in neurological function with relief of facial pain; cerebellar ataxia also improved somewhat in 3/4 of the patients; spreading nerve and talocrural nerve palsy also recovered in 2 patients. A total of 8 patients with dumbbell-type trigeminal nerve sheath tumor were included in the study. 4 patients diagnosed before 2007 had the tumor removed using a posterior sigmoid sinus approach, while 4 patients diagnosed after 2007 had the tumor removed using an endoscopic-assisted posterior sigmoid sinus approach. On the basis of microsurgery, the tumor was found to be completely resected in one patient, while the other three patients had residual tumor in the Meckel cavity, which was eventually resected completely under endoscopy. The location of the residual tumor in all three cases was superiorly and anterolaterally in the Meckel cavity, and there were no endoscopy-related complications after surgery. This study demonstrates that trigeminal nerve sheath tumors can be safely and effectively eradicated with endoscopic assistance based on the posterior sigmoid sinus approach, and endoscopic-assisted resection of dumbbell-shaped tumors is particularly recommended to avoid serious complications and death caused by other surgical approaches. The posterior sigmoid sinus approach with endoscopic assistance is a safe choice for the treatment of lesions that span the apical part of the rock occupying the middle and posterior cranial fossa.