The surgical management issues of 73 cases of trigeminal neurinoma treated over a 12-year period were analyzed. The case records and radiologic material of 73 patients with trigeminal neurinoma operated on in the Neurosurgery Department at King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, between the year 1989 and 2001 were retrospectively analyzed. The appropriateness of the selected surgical route is studied. Apart from the other typical presenting features of trigeminal schwannoma, 9 patients presented with the rarely reported symptom of pathologic laughter. Three approaches were found appropriate to treat these tumors: the infratemporal fossa interdural approach, the lateral basal subtemporal approach, and the retrosigmoid approach. In 51 (69.9%) cases, total tumor excision was achieved. Two patients died during the postoperative period. During an average follow-up of 38 months, there has been a recurrence in 1 case and 71 patients are leading an independent and active life. Radical surgery is associated with an excellent clinical outcome and long-term tumor control. A majority of tumors, even those that are large and multicompartmental, can be removed in a single surgical stage and exposure.