Endoscopic endonasal approach for the treatment of schwannomas of the pterygopalatine fossa: case report and review of the literature

Abstract

Introduction: Pterygopalatine fossa (PPF) schwannomas are rare lesions most often arising from branches of the trigeminal nerve. Symptomatic lesions have been traditionally treated by conventional external approaches. However, the development of an expanded endonasal approach (EEA) enables skull base surgeons to reach these deeply seated lesions via a different route with its own advantages and drawbacks.

Methods: Case report and review of the literature.

Case description: A 41-year-old woman presented with a 6-year history of right facial pain and numbness. Her symptoms had increased progressively over a year, and she recently had developed right-sided otalgia. MRI revealed a right PPF mass, hypointense on T1 and T2 sequences with homogeneous enhancement following the use of gadolinium. A biopsy, attempted at another institution, was considered non-diagnostic. We totally removed the lesion through an endoscopic endonasal transmaxillary approach. Final pathology confirmed the diagnosis of schwannoma. Post-operatively, the patient noted a significant improvement of her facial pain (V2 territory).

Conclusion: The endonasal endoscopic transmaxillary approach provides adequate access to the PPF, thus enabling safe tumor removal with less morbidity than conventional routes.

Keywords: Chirurgie endoscopique endonasale; Endonasal endoscopic surgery; Fosse ptérygopalatine; Nerf trijumeau; Pterygopalatine fossa; Schwannoma; Schwannome; Trijeminal nerve.