title: Combined craniofacial approach for the removal of a large trigeminal schwannoma invading the infratemporal fossa.
abstract: BACKGROUND
  Trigeminal schwannomas are rare tumours accounting for 0.07-0.36% of all intracranial tumours and 0.8-8% of intracranial schwannomas. Symptoms and signs of these lesions depend on the site of the tumour, which may compress the nerve of origin or adjacent nerves.
  
  
  METHODS
  We describe a case of a 69-year-old woman with a history of progressively worsening hypoesthesia involving the third division of the trigeminal nerve. A tumour of 5-cm diameter was revealed within the right cranial middle fossa, extending to the lateral wall of the cavernous sinus, the infratemporal fossa and the posterior wall of the maxillary sinus. A combined craniofacial approach was undertaken. A right extended subtemporal craniotomy was performed. The intracranial component of the tumour, originating from the third division of the trigeminal nerve and compressing the cavernous sinus, was removed in total. We proceeded with a Weber-Ferguson approach through which the extracranial component of the tumour was also totally resected. The postoperative computed tomography of the head has shown complete tumour removal. The histopathologic examination revealed a cellular neurinoma. Postoperatively, the patient expressed a transitory palsy of the oculomotor nerve, which resolved within a few weeks. The patient remains free of recurrence with mild hypoesthesia of the third trigeminal branch 5 years after treatment.
  
  
  CONCLUSIONS
  Surgery of trigeminal schwannomas may be a very challenging task. Various surgical approaches for trigeminal schwannomas excision have been described. With this combined approach, the tumour was freed from the surrounding tissues and was easily and totally removed.
authors.affiliation: Oral and Maxillofacial Surgery Department, General Hospital of Athens KAT, Nikis 2 St, Kifissia, 14561, Attica, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Rallis
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Stathopoulos
authors.forename: Michael
authors.initials: M
authors.lastname: Mezitis
authors.forename: Nicholas
authors.initials: N
authors.lastname: Sakellaridis
authors.forename: Helen
authors.initials: H
authors.lastname: Machera
authors.forename: Nicholas
authors.initials: N
authors.lastname: Zachariades
mesh_terms: D000368:Aged; D035301:Cranial Fossa, Middle / Q000000981:diagnostic imaging / Q000601:surgery; D003390:Cranial Nerve Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D009442:Neurilemmoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D014057:Tomography, X-Ray Computed; D020433:Trigeminal Nerve Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*