Objective To investigate the best surgical approach to remove of trigeminal neurinomas (TNs).　Methods 75 patients with TNs in Huashan Hospital were reviewed retrospectively. Results In early group (1978～1984) conventional intradural approaches were used, and in late group (1985～1995) an epidural approach via the skull-base craniotomy was utilized. Total removal of was achieved in 58%(20/35) in the early group and 80% (32/40)(P<0.05) in the late group. emporary or permanent cranial nerves morbidities were 62.7%, 37% in the early group and 28.1%, 10% (P<0.01) in the late group, respectively. Conclusions 　The best surgical approach with microsurgical technique for removal of TNs is epidural approach or epiduro-trans-duro-transtentorial approach via a skull-base craniotomy except the tumor only confined to the posterior fossa