Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb;164(2):331-341.
doi: 10.1007/s00701-021-05068-8. Epub 2021 Nov 23.

Endoscopic endonasal transmaxillary-pterygoid approach for skull-base non-vestibular schwannomas in 10 consecutive patients

Yusuke Morinaga #  1   2 , Hiroyoshi Akutsu #  3   4 , Hiroyoshi Kino  1 , Takuma Hara  1 , Shuho Tanaka  5 , Hidetaka Miyamoto  5 , Masahide Matsuda  1 , Eiichi Ishikawa  1
Affiliations

Endoscopic endonasal transmaxillary-pterygoid approach for skull-base non-vestibular schwannomas in 10 consecutive patients

Yusuke Morinaga et al. Acta Neurochir (Wien). 2022 Feb.

Abstract

Purpose: Non-vestibular schwannomas (NVSs) of the skull base occur in several sites, and few previous studies have evaluated the usefulness of the endoscopic endonasal transmaxillary-pterygoid approach (EETMPA) to resect these lesions. We aimed to evaluate the characteristics and clinical outcomes of patients who underwent EETMPA for skull-base NVSs and to investigate the efficacy, safety, and indications for the procedure.

Methods: We retrospectively reviewed the clinical data of 10 consecutive patients (mean age, 45 ± 17) who underwent EETMPA for skull-base NVSs at the University of Tsukuba hospital between 2013 and 2020. We also calculated the total tumor volume and the size of the corridor to the tumor for EEA (SCEEA) in nine patients who underwent EEA for NVSs adjacent to the Meckel's cave or cavernous sinus.

Results: Nine patients (9/10), including five women (5/10), underwent primary surgery. Gross total resection and subtotal resection were achieved in five patients each (5/10). Postoperatively, one patient showed a new and mild cranial nerve V sensory deficit and one patient showed slight worsening of abducens nerve palsy. The greater palatine nerve was amputated in two patients; however, permanent perception loss in the soft palate was observed in one patient. The Vidian nerve was sacrificed in four patients, and new dry eye occurred in one patient. None of the patients experienced postoperative tumor recurrence or regrowth during the follow-up period of 40 ± 28 months.

Conclusion: EETMPA is safe and effective for excising skull-base NVSs which are not eligible for radiosurgery leading to a high rate of successful resection and a high rate of but mild neurological sequela. The EEA is appropriate when the tumor extends to the paranasal sinus with sufficient SCEEA.

Keywords: Endonasal transmaxillary-pterygoid approach; Endoscopic endonasal surgery; Non-vestibular schwannoma; Retrospective study; Transmaxillary-pterygoid approach.

PubMed Disclaimer

References

    1. Esposito F, Dusick JR, Fatemi N, Kelly DF (2007) Graded repair of cranial base defects and cerebrospinal fluid leaks in transsphenoidal surgery. Oper Neurosurg (Hagerstown) 60:295–303; discussion 303–304. https://doi.org/10.1227/01.NEU.0000255354.64077.66
    1. Fujimoto Y, Ramos HF, Mariani PP, Romano FR, Cukiert A, Bor-Seng-Shu E, Wakayama A, Yoshimine T (2015) Superior turbinectomy: role for a two-surgeon technique in endoscopic endonasal transsphenoidal surgery–technical note. Neurol Med Chir (Tokyo) 55:345–350. https://doi.org/10.2176/nmc.tn.2014-0159 - DOI
    1. Garcia ECD, Rossaneis AC, Pipino AS, Gomes GV, Pinna FDR, Voegels RL, Doty RL, Aparecidori WA, Fornazieri MA (2020) Safety and efficacy of superior turbinate biopsies as a source of olfactory epithelium appropriate for morphological analysis. Eur Arch Otorhinolaryngol 277:483–492. https://doi.org/10.1007/s00405-019-05728-7 - DOI - PubMed
    1. Hara T, Akutsu H, Yamamoto T, Tanaka S, Yasuda M, Takano S, Kino H, Miyamoto H, Matsumura A (2018) Combined endoscopic endonasal and transoral surgery for a chordoma in the whole clivus with marked caudal extension. Oper Neurosurg (Hagerstown) 14:463–464. https://doi.org/10.1093/ons/opx168 - DOI
    1. Kalliny ME, Loveren HV, Keller JT, Tew JM Jr (1992) Tumors of the lateral wall of the cavernous sinus. J Neurosurg 77:508–514. https://doi.org/10.3171/jns.1992.77.4.0508 - DOI - PubMed

LinkOut - more resources