Extended frontal approach with bilateral orbitofrontoethmoidal osteotomiesfor removal of a giant extracranial schwannoma in the nasopharynx, sphenoid sinus, and parapharyngeal space

BACKGROUND Although parapharyngeal schwannomas are not uncommon, schwannoma s of the nasopharynx and paranasal sinuses are rare lesions. In the absence of intracranial extension, they are usually removed with transantral, late ral rhinotomy or more complex transfacial approaches. CASE DESCRIPTION We report a 24-year-old patient with a giant benign schwan noma involving the superior parapharyngeal space, pterygopalatine fossa, na sopharynx, and sphenoid sinus with erosion into the clivus that was removed with an extended frontal approach including bilateral orbito-frontoethmoid al osteotomies. CONCLUSION The advantages of the extended subfrontal over more standard tra nsfacial approaches for lesions in this location include the early dissecti on of critical neural structures, preserving cosmetics and facilitating man agement of an inadvertent cerebrospinal fluid leak. (C) 2001 by Elsevier Sc ience Inc.