title: Surgical management of giant trigeminal schwannomas extending into the parapharyngeal space.
abstract: OBJECTIVE
  Trigeminal schwannomas extending into the deep parapharyngeal space are relatively rare, and a surgical approach to such tumors has not been well established. We report four cases in which the tumors were completely removed by using a combination of three approaches.
  
  
  METHODS
  Four patients with trigeminal schwannomas extending into the extracranial space were surgically treated using a combination of the transcervical approach, anterolateral retromaxillar pathway via gingivobuccal sulcus, and epi and interdural middle fossa approach.
  
  
  RESULTS
  The maximum diameters of the tumors ranged from 4 to 7 cm. Three tumors extended beyond the lower end of the maxillary sinus. All tumors were completely excised. The Karnofsky performance scales after surgery were more than 90% in all patients.
  
  
  CONCLUSIONS
  Although the tumors extending to the deep parapharyngeal space are difficult to completely remove via a single approach, a combined approach is useful in these huge extracranial extensions.
authors.affiliation: Skull Base Center, International University of Health and Welfare, Mita Hospital, Tokyo, Japan. hjimbo@tokyo-med.ac.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Jimbo
authors.forename: Shinetsu
authors.initials: S
authors.lastname: Kamata
authors.forename: Kouki
authors.initials: K
authors.lastname: Miura
authors.forename: Shunji
authors.initials: S
authors.lastname: Asamoto
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Masubuchi
authors.forename: Yukio
authors.initials: Y
authors.lastname: Ikeda
authors.forename: Jo
authors.initials: J
authors.lastname: Haraoka
mesh_terms: D000328:Adult; D035301:Cranial Fossa, Middle / Q000033:anatomy & histology / Q000601:surgery; D003390:Cranial Nerve Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D003399:Craniotomy / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008437:Maxilla / Q000033:anatomy & histology / Q000601:surgery; D008443:Maxillary Sinus / Q000033:anatomy & histology / Q000601:surgery; D008875:Middle Aged; D009055:Mouth / Q000033:anatomy & histology / Q000601:surgery; D009333:Neck / Q000033:anatomy & histology / Q000601:surgery; D009442:Neurilemmoma / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods* / Q000706:statistics & numerical data; D010614:Pharynx / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000379:methods; D013355:Subdural Space / Q000033:anatomy & histology / Q000601:surgery; D016896:Treatment Outcome; D014276:Trigeminal Nerve / Q000473:pathology / Q000601:surgery*; D020433:Trigeminal Nerve Diseases / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*