Novel Single-Stage Transcervical Submandibular Approach for a Giant Multicompartmental Pterygopalatine Fossa Schwannoma: A Case Report and Surgical Strategy.

Abstract

Background: Giant schwannomas originating in the pterygopalatine fossa (PPF) with multicompartmental extension pose a considerable surgical challenge.

Case presentation: This report details the management of a 34-year-old female who presented with progressive facial numbness, dysphagia, and unilateral facial asymmetry secondary to a voluminous PPF schwannoma.

Imaging findings: Preoperative imaging characterized a solid-cystic expansile mass with involvement of the maxillary sinus, infratemporal fossa, parapharyngeal space, and the anterolateral craniovertebral junction, including encasement of the internal carotid artery.

Surgical approach: Given the tumor's significant lateral and posterior-inferior extension that precluded a purely endoscopic resection, a tailored transcervical submandibular approach was utilized. This open corridor provided direct lateral access, enabling safe proximal vascular control and permitting meticulous neurovascular dissection.

Results: Gross-total resection was ultimately achieved without the need for mandibular osteotomy or transfacial incisions. The patient's postoperative course was uncomplicated, with preservation of neurological function, and follow-up imaging confirmed complete resection.

Conclusion: This case highlights the novel single-stage transcervical submandibular approach as a viable and effective surgical strategy for select, extensive PPF schwannomas with dominant lateral and neurovascular involvement, serves as a critical alternative when endoscopic access is insufficient. To our knowledge, this is the first report of a single-stage transcervical submandibular resection for a multicompartmental PPF schwannoma with such extensive lateral and vascular involvement, unlike previous studies have described multi-staged procedures for similar complex lesions.