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Endoscopic Endonasal Approach for Nonvestibular Schwannomas

Shin, Samuel S. PhD*; Gardner, Paul A. MD; Stefko, S. Tonya MD§; Madhok, Ricky MD; Fernandez-Miranda, Juan C. MD; Snyderman, Carl H. MD

doi: 10.1227/NEU.0b013e3182287bb9
Research-Human-Clinical Studies

BACKGROUND: Nonvestibular schwannomas of the skull base often represent a challenge owing to their anatomic location. With improved techniques in endoscopic endonasal skull base surgery, resection of various ventral skull base tumors, including schwannomas, has become possible.

OBJECTIVE: To assess the outcomes of using endoscopic endonasal approach (EEA) for nonvestibular schwannomas of the skull base.

METHODS: Seventeen patients operated on for skull base schwannomas by EEA at the University of Pittsburgh Medical Center from 2003 to 2009 were reviewed.

RESULTS: Three patients underwent combined approaches with retromastoid craniectomy (n = 2) and orbitopterional craniotomy (n = 1). Three patients underwent multistage EEA. The rest received a single EEA operation. Data on degree of resection were found for 15 patients. Gross total resection (n = 9) and near-total (>90%) resection (n = 3) were achieved in 12 patients (80%). There were no tumor recurrences or postoperative cerebrospinal fluid leaks. In 3 of 7 patients with preoperative sensory deficits of trigeminal nerve distribution, there were partial improvements. Patients with preoperative reduced vision (n = 1) and cranial nerve VI or III palsies (n = 3) also showed improvement. Five patients had new postoperative trigeminal nerve deficits: 2 had sensory deficits only, 1 had motor deficit only, and 2 had both motor and sensory deficits. Three of these patients had partial improvement, but 3 developed corneal neurotrophic keratopathy.

CONCLUSION: An EEA provides adequate access for nonvestibular schwannomas invading the skull base, allowing a high degree of resection with a low rate of complications.

ABBREVIATIONS: CN: cranial nerve

EEA: endoscopic endonasal approach

ICA: internal carotid artery

RMC: retromastoid craniectomy

*University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Departments of ‡Neurological Surgery

§Ophthalmology

‖Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Correspondence: Paul A. Gardner, MD, Department of Neurological Surgery, University of Pittsburgh Medical Center, UPMC Presbyterian, Ste B-400, 200 Lothrop St, Pittsburgh, PA 15213. E-mail: gardpa@upmc.edu

Received September 1, 2010

Accepted March 25, 2011

Copyright © by the Congress of Neurological Surgeons