Strategic Management of Anterior Skull Base Schwannomas and Their Outcomes

Endoscopic endonasal approach has revolutionized the surgery of benign nose and paranasal sinus tumors. In this study we describe our experience with this approach for schwannomas of anterior skull base which are extremely rare, vascular tumors of this region. We also discuss the strategic management and their outcomes to enlighten the existing literature.

Ambispective study.

A total of eight cases of anterior skull base schwannoma were included. These cases were operated between 2018 and 2023 at a tertiary institute. Institutional ethical committee approval was obtained.

Medical records were obtained, and perioperative details (intraoperative findings, imaging findings, complications) were noted. Postoperative follow-up was done to note the outcomes of the patient.

There were five male and three female patients. All patients were between 20 and 40 years of age. All patients underwent contrast CT as well as MRI preoperatively. Most common symptoms in our series were nasal obstruction and intermittent epistaxis. The various sites involved were ethmoid labyrinth, maxillary sinus, septum, and olfactory fossa. All the cases were operated endoscopically.

Endoscopic approach can be utilized in almost all cases of benign anterior skull base tumors with superior postoperative outcomes. Although there is a steep learning curve, use of subtle modifications of this technique help achieve better results. At the same time, it is imperative to understand that the surgeon should also be well versed with open approaches to help navigate difficult cases.