J Neurol Surg B Skull Base 2015; 76 - A042
DOI: 10.1055/s-0035-1546509

Resection of Schwannomas Arising Pterygopalatine Fossa with Transzygomatic Transcranial Approach

Yiqun Wu 1, Baohua Fan 1, Huayi Cheng 1, Chenping Zhang 2, Tong Ji 2, Zhiyuan Zhang 2
  • 1Neurosugery, Shanghai 9th Hospital, Shanghai Jiaotong University School of Medicine, China
  • 2Department of Oral Maxillary and Head and Neck Oncology, Shanghai 9th Hospital, Shanghai Jiaotong Un, China

Background: Schwannomas of pterygopalatine fossa are the benign tumors that mostly arise from the trigeminal nerve. The tumor might protrude into the middle cranial fossa and even the cavernous sinus. Several approaches such as transmandibular ramus, transmaxillar, and transnasal endoscopy can access this region but their limitations are also obvious. We present a series of 21 cases of schwannomas arising pterygopalatine fossa that were removed with the transzygomatic transcranial approach.

Method: In this series of cases, the average age of patients is 42.4 years with 9 males versus 12 females. And the diagnosis was demonstrated by CT and MRI scanning. Preoperative needle puncture biopsy pathological studies were obtained. All procedures applied transzygomatic and transcranial extradural and the mandibular and facial nerve were kept intact.

Result: The total tumor removed was archived in all cases including the cases that tumors protruding into the cavernous sinus. The function of the facial nerve and mandibular were fully preserved and the trigeminal nerve was anatomically preserved successfully in about 50% of patients. No complication was found in our limited experience.

Conclusion: Although it has remaining a little bit risk in the surgical procedure with craniotomy, the transzygomatic, and transcranial extradural approach applied to resection of pterygopalatine fossa schwannomas presented its own advantages compared with other surgical approaches. The exploration of the lesion was sufficient even with the giant tumor lower down to the level of parotid gland so as to accessing to cavernous sinus and preserving the trigeminal nerve and its branches. It can also avoid injuring the mandibular of maxillary bone structure and facial nerve and the procedure meets the patient's concern of cosmetic well as the incision is hided mostly in hair.

Keywords

schwannoma - pterygopalatine fossa - surgical resection - transcranial - transzygomatic