title: Extended frontal approach with bilateral orbitofrontoethmoidal osteotomies for removal of a giant extracranial schwannoma in the nasopharynx, sphenoid sinus, and parapharyngeal space.
abstract: BACKGROUND
  Although parapharyngeal schwannomas are not uncommon, schwannomas of the nasopharynx and paranasal sinuses are rare lesions. In the absence of intracranial extension, they are usually removed with transantral, lateral rhinotomy or more complex transfacial approaches.
  
  
  METHODS
  We report a 24-year-old patient with a giant benign schwannoma involving the superior parapharyngeal space, pterygopalatine fossa, nasopharynx, and sphenoid sinus with erosion into the clivus that was removed with an extended frontal approach including bilateral orbitofrontoethmoidal osteotomies.
  
  
  CONCLUSIONS
  The advantages of the extended subfrontal over more standard transfacial approaches for lesions in this location include the early dissection of critical neural structures, preserving cosmetics and facilitating management of an inadvertent cerebrospinal fluid leak.
authors.affiliation: Department of Neurological Surgery, New York Presbyterian Hospital, New York, New York 10021, USA.
authors.forename: T H
authors.initials: TH
authors.lastname: Schwartz
authors.forename: J N
authors.initials: JN
authors.lastname: Bruce
mesh_terms: D000328:Adult; D005005:Ethmoid Sinus / Q000601:surgery; D005626:Frontal Sinus / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D009442:Neurilemmoma / Q000175:diagnosis / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D009915:Orbit / Q000601:surgery; D010027:Osteotomy / Q000379:methods*; D010255:Paranasal Sinus Neoplasms / Q000175:diagnosis / Q000601:surgery*; D013101:Sphenoid Sinus / Q000473:pathology / Q000601:surgery