Endoscopic Transpterygoid Approach to Infrapetrous Region for Cranial Nerve V Schwannoma

Introduction: Trigeminal Schwannomas are rare tumors and correspond to 0.07 to 0.30% of all intracranial tumors and 0.8 to 8% of intracranial schwannomas. It is more frequent between 40 and 60 years, and predominantly in females. Fifth cranial nerve schwannoma can arrive any intracranial or extracranial portion and can arise from nerve root, Gasser ganglion, or one of the three peripheral branches of trigeminal nerve as ophthalmic, maxillary, and mandibular. The symptoms and treatment depend on the location and extent of the tumor. Several surgical techniques have been described for the therapeutic approach, but the most involve craniotomy. It is imperative a radical surgery due the high chance of recurrence of the tumor.

Objectives: This study aims to describe surgical endoscopic endonasal approach infrapetrous transpterygoid in the treatment of trigeminal schwannoma.

Resumed Report: A 56-year-old male patient, complained of facial pain and left facial hypoesthesia, with 2 years’ duration. Magnetic resonance imaging showed the presence of tumor (2 × 3 cm) located in the topography of left Gasser ganglion, adjacent to the petrous portion of the internal carotid artery and internal jugular vein. It was opted by endoscopic endonasal surgical approach infrapetrous transpterygoid access. Patient recovered well, uneventfully after surgery, remaining in the intensive care unit for 36 hours, and discharged on the 5th day with subsequent symptomatic improvement.

Conclusion: The endonasal endoscopic approach, although not a widely used approach in the fifth cranial nerve schwannoma, is an excellent treatment option because of its lower morbidity, shorter hospital stay, and lower risk of intraoperative and postoperative complications.