The intranasal endoscopic removal of schwannoma of the pterygopalatine and infratemporal fossae via the prelacrimal recess approach

Abstract

Objective: This study was undertaken to analyze the results of a novel surgical method-the endoscopic prelacrimal recess approach (PLRA)-in patients with tumors involving the pterygopalatine fossa (PPF) and infratemporal fossa (ITF). The surgical technique and indications for this approach are also discussed.

Methods: The authors analyzed data from 7 cases involving patients who underwent resection of PPF and ITF tumors by means of the endoscopic PLRA from 2004 to 2013. Preoperative and postoperative imaging studies were available in all cases and were reviewed. The surgical specimens were all confirmed to be schwannomas.

Results: All tumors were completely resected via endoscopic PLRA. There were no recurrences noted over a 28-month follow-up period. In 4 cases, the patients experienced postoperative facial numbness during the first two weeks after surgery, which gradually lessened thereafter. One patient continued to have mild facial numbness at most recent follow-up. The numbness had fully resolved in the other 3 cases.

Conclusions: The intranasal endoscopic removal of schwannoma from PPF and ITF via PLRA can spare the whole lateral nasal wall, resulting in a reduction in morbidity. This is a novel minimally invasive surgical method for PPF and ITF tumors.

Keywords: IMA = internal maxillary artery; ITF = infratemporal fossa; PLRA = prelacrimal recess approach; PPF = pterygopalatine fossa; TEM = transnasal endoscopic maxillectomy; endoscopic sinus surgery; infratemporal fossa; prelacrimal recess; pterygopalatine fossa; schwannoma; surgical technique.