[Endoscopic Surgery for Trigeminal Schwannoma]

Area of Science:

• Neurosurgery
• Otolaryngology
• Minimally Invasive Surgery

Background:

• Trigeminal schwannomas are rare tumors.
• Minimally invasive endoscopic techniques are increasingly used for their surgical treatment.
• Patient selection criteria and technical details for these approaches are not well-established.

Purpose of the Study:

• To describe patient selection criteria and technical nuances for endoscopic endonasal transmaxillary-pterygoid approach (EETMPA), endoscopic transorbital approach (ETOA), and endoscopic keyhole approach (EKA) in treating trigeminal schwannomas.
• To share insights from previous work to guide surgical practice.

Main Methods:

• Review of previous surgical work on trigeminal schwannomas using EETMPA, ETOA, and EKA.
• Detailed description of patient selection based on MRI identification of surgical corridors.
• Explanation of surgical steps including sphenoidotomy, ethmoidectomy, maxillary sinus wall removal, and pterygopalatine fossa opening for EETMPA.
• Emphasis on intracapsular dissection technique during tumor resection.

Main Results:

• EETMPA requires a sufficient surgical corridor identified on MRI.
• Adequate working space is achieved through sphenoidotomy, ethmoidectomy, maxillary sinus wall removal, and pterygopalatine fossa opening.
• Intracapsular dissection is crucial for preserving trigeminal nerve fibers.
• Favorable outcomes were observed with EETMPA, attributed to precise selection and resection techniques.

Conclusions:

• Minimally invasive endoscopic approaches, particularly EETMPA, show promise for trigeminal schwannoma treatment.
• Careful patient selection and meticulous surgical technique, including intracapsular dissection, are vital for successful outcomes.
• Further clinical experience will likely refine the selection criteria for EETMPA, ETOA, and EKA.