Surgical excision of trigeminal (V3) schwannoma through endoscopic transpterygoid approach
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Ravisankar M, Khatri D, Gosal JS, Arulalan M, Jaiswal AK, Das KK. Surgical excision of trigeminal (V3) schwannoma through endoscopic transpterygoid approach. Surg Neurol Int 2019;10:259.
Endoscopic endonasal transpterygoid (EET) approach is well suited for trigeminal schwannomas.
A 25-year-old female presented with the right hemifacial pain for 1 month. Examination revealed mild sensory loss to both touch and pain in the right V2 and V3 dermatomal distribution. On magnetic resonance imaging, a well-defined extra-axial lesion was seen in the right infratemporal fossa extending intracranially, widening the foramen ovale. Erosion of the lateral pterygoid plate was evident on computed tomography. Diagnosis of a trigeminal schwannoma was made and excision through endoscopic transnasal transpterygoid approach was planned. After adequate nasal decongestion, lateralization of the inferior turbinate followed by medialization of middle turbinate done to expose the posterior part of the lateral nasal wall. Sphenopalatine foramen was visualized and the branches of the sphenopalatine artery to turbinate were coagulated followed by partial inferior and middle turbinectomy. Next, antegrade uncinectomy, bullectomy, and middle meatal antrostomy performed. Anterior and posterior ethmoidectomy was done to gain access to the sphenoid sinus. Medial maxillectomy done, posterior maxillary sinus wall exposed and drilled to reach infratemporal fossa harboring the tumor. The lateral recess was further exposed to visualize the vidian and maxillary nerves. Palatine bone and pterygoid body along with the medial pterygoid plate were completely drilled to expose the tumor capsule, which was gently dissected off. Complete tumor excision was performed uneventfully.
EET provides a good oncological and functional outcome. With a lesser risk of surgical morbidities, it is an excellent alternative to conventional skull base approaches to trigeminal schwannomas in the modern era.
Videos available on:
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.