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Acta Neurochirurgica

, Volume 157, Issue 6, pp 935–938 | Cite as

Total removal of a trigeminal schwannoma via the expanded endoscopic endonasal approach. Technical note

  • Timothée JacquessonEmail author
  • Moncef Berhouma
  • Thiébaud Picart
  • Emmanuel Jouanneau
Technical Note - Neurosurgical Techniques

Abstract

Background

Because of their deep location surrounded by closed numerous neurovascular structures, skull base tumors of the cavernous sinus are still difficult to manage. Recently, the endoscopic endonasal approach commonly used for pituitary tumor resection has been “expanded” to the parasellar, infratemporal and orbital compartments with some advantages compared to the intracranial route.

Methods

The authors reported the case of a 49-year-old male presenting a large extradural tumor of the left cavernous sinus with extensions toward the orbit, sphenoid sinus and infratemporal fossa. His ophthalmological examination was normal, and the body CT scan revealed no primary neoplasm.

Results

In this operative video, the approach is described step by step with surgical nuances. The endoscopy provided a close-up panoramic view and various angles of vision. Also, it avoided an invasive craniotomy, cerebral retraction and cranial nerves damages. Thus, it allowed the total removal of this tumor originating from the maxillary branch of the trigeminal nerve. The pathologic examination confirmed a schwannoma.

Conclusion

The expanded endoscopic endonasal approach provides an interesting corridor to cavernous sinus tumors with satisfactory control of extensions inferiorly toward the infratemporal fossa, anteriorly via the superior orbital fissure and medially within the sphenoid. Finally, the skull base surgeon has to master this anterior endoscopic route as well as all the other “open” transcranial skull base approaches to propose the best surgical route fitting the tumor characteristics.

Keywords

Skull base Schwannoma Cavernous sinus Meckel’s cave Endoscopy Endonasal 

Notes

Conflicts of interest

None.

Supplementary material

Video 1

This video illustrates the expanded endoscopic endonasal approach to this cavernous sinus tumor with comments about the strategy and surgical nuances. (MOV 62,085 kb)

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Copyright information

© Springer-Verlag Wien 2015

Authors and Affiliations

  • Timothée Jacquesson
    • 1
    • 2
    Email author
  • Moncef Berhouma
    • 1
  • Thiébaud Picart
    • 1
  • Emmanuel Jouanneau
    • 1
  1. 1.Multidisciplinary Skull Base Unit, Department of Neurosurgery B, Neurological Hospital Pierre WertheimerHospices Civils de LyonLyon CedexFrance
  2. 2.Department of AnatomyUniversity of Lyon 1LyonFrance

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