Endoscopic Transvestibular Transmandibular approach for trigeminal schwannoma in the infratemporal fossa and parapharyngeal space: a case report

Schwannomas that involve the mandibular division of the trigeminal nerve and localize exclusively in the parapharyngeal space (PPS) and infratemporal fossa (ITF) are extremely rare, and a surgical approach to treat such tumours has not been well established. We present our experience in the treatment of a giant trigeminal schwannoma with wide extension in the ITF and PPS using an endoscopic transvestibular transmandibular approach. The clinical and radiological findings, preoperative planning, advantages of the surgical approach and the clinical outcome are discussed. Schwannomas located in the ITF and PPS are rare benign neoplasms. They are usually detected late after considerable signs and symptoms appear. Preoperative planning is beneficial to individual surgical approach selection. Total surgical excision following careful evaluation of preoperative CT and MRI images is the treatment of choice. Recurrence is rare after complete excision.