Combined endoscopic endonasal transpterygoid and sublabial transmaxillary approaches for a large infratemporal fossa trigeminal schwannoma

Edoardo Agosti; A Yohan Alexander; Garret Choby; Maria Peris-Celda; Carlos D Pinheiro-Neto

doi:10.1007/s00701-022-05327-2

Combined endoscopic endonasal transpterygoid and sublabial transmaxillary approaches for a large infratemporal fossa trigeminal schwannoma

Acta Neurochir (Wien). 2022 Sep;164(9):2525-2531. doi: 10.1007/s00701-022-05327-2. Epub 2022 Aug 4.

Authors

Edoardo Agosti^{1

2

3}, A Yohan Alexander^{1

2}, Garret Choby^{1

2

4}, Maria Peris-Celda^{1

2

4}, Carlos D Pinheiro-Neto^{5

6

7}

Affiliations

¹ Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, MN, USA.
² Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA.
³ Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
⁴ Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
⁵ Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, MN, USA. pinheironeto.carlos@mayo.edu.
⁶ Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA. pinheironeto.carlos@mayo.edu.
⁷ Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA. pinheironeto.carlos@mayo.edu.

PMID: 35922721
DOI: 10.1007/s00701-022-05327-2

Abstract

Background: Trigeminal schwannomas (TSs) with solitary extracranial location are rare, and surgical excision is challenging. In recent years, the endoscopic endonasal transmaxillary transpterygoid approach (EETPA) has been advocated as an effective strategy for TSs in the infratemporal fossa (ITF).

Method: We describe the steps of the EETPA combined with the sublabial transmaxillary approach for the surgical excision of a giant mandibular schwannoma of the ITF. Indications, advantages, and approach-specific complications are also discussed. The main surgical steps are shown in an operative video.

Conclusion: A combined EETPA and sublabial transmaxillary approach represents a safe and effective option for the surgical excision of extracranial TSs.

Keywords: Endoscopic endonasal; Infratemporal fossa; Sublabial; Transmaxillary; Transpterygoid; Trigeminal schwannoma.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cranial Nerve Neoplasms* / diagnostic imaging
Cranial Nerve Neoplasms* / surgery
Endoscopy
Humans
Infratemporal Fossa*
Neurilemmoma* / diagnostic imaging
Neurilemmoma* / surgery
Nose / surgery