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Objective To investigate the efficacy and safety of cranio - orbital approach for the removal of cavernous sinus - orbital communication trigeminal schwannomas. Methods and Results A total of 23 patients with cavernous sinus-orbital communication trigeminal schwannoma were included from January 2013 to January 2019, the combined cranio-orbital approach (modified Dolenc approach combined with supraorbital approach) was used for surgical resection of tumors. Total tumor resection was performed in 20 cases and nearly total resection in 3 cases. Thirteen patients with preoperative visual loss, 7 of them further decreased visual acuity; 5 cases with preoperative eye movement disorder and/or ptosis, 3 cases with residual eye movement disorder, and 11 cases appeared new eye movement disorders after surgery. None of the 23 cases occurred cerebrospinal fluid leakage, intracranial hematoma or intracranial infection occurred, no death and no tumor recurrence case. Conclusions Cavernous sinus-orbital communication trigeminal schwannoma, due to the special tumor occurrence site and surrounding anatomical structure, was easy to cause complications such as visual loss and eye movement disorder during operation. The combined cranio-orbital approach was used, it may increase the total resection rate, and also show relatively low surgical complications rate. [ABSTRACT FROM AUTHOR]