Endoscopic Endonasal Approach for Trigeminal Schwannomas: Tailored Approaches Based on Lesion Traits

Abstract

ObjectivesTo describe four endoscopic endonasal subapproaches, namely, the trans‐lamina papyracea, trans‐prelacrimal recess, trans‐Meckel's cave, and transclival approaches for trigeminal schwannomas (TSs).MethodsThis retrospective study reviewed the medical records and intraoperative videos of 38 patients with TSs who underwent endoscopic endonasal approach (EEA) between Jan 2013 and Dec 2021.ResultsAccording to Jeong's classification, for TS equally in middle and posterior fossae (MP), a purely trans‐Meckel's cave approach was carried out in 2 cases, and a combined transclival approach was carried out in 4 cases. The four tumors that involved infratemporal fossa (two E3, one mE3, and one Mpe3) were performed via a trans‐prelacrimal recess approach, and type Mpe3 was also assisted by the trans‐Meckel's cave approach. One patient with type E1 was treated with a trans‐lamina papyracea approach. The other 27 cases, including type M, Mp, ME2, and MpE2, were all removed by a purely trans‐Meckel's cave approach. Thirty‐six patients (97.4%) received total resection under a purely EEA. The functional abilities and preoperative symptoms of 31 patients (88.6%) improved. Eight (21.1%) patients experienced permanent neurological function deficits. Postoperative cerebrospinal fluid and intraoperative internal carotid artery injury occurred in 1 (2.6%) patient.ConclusionAccording to the specific endoscopic endonasal subapproaches corresponding to the different TS locations, satisfactory results can be obtained for most types of tumors. It represents an effective alternative to the open transcranial approach and can also be properly used in most types of TS with experienced hands.Level of Evidence4 Laryngoscope, 133:2564–2571, 2023