Subtemporal Epidural and Interdural Approach for the Greater Petrosal Nerve Schwannomas

Abstract

Schwannomas arising from the greater petrosal nerve (GPN) are exceedingly rare: only 10 such cases have been reported in the English literature. We report on 4 cases of GPN schwannomas and discuss the surgical approach for their removal. 4 patients with GPN schwannomas underwent surgery at Keio University Hospital We present the pre- and postoperative clinical findings and describe the structures around the GPN schwannomas as observed during the surgery. Histological sections were performed around the GPN using Masson's trichrome stain to elucidate the membrane structures. Three patients presented with xerophthalmia, and one with facial palsy, hearing disturbance, and generalized convulsions. Contrast-enhanced magnetic resonance (MR) images revealed tumors in the temporal lobe. Bone-window computed tomography (CT) showed erosion of the anterior petrous apex. During the operation, the temporal lobe was retracted epidurally. The tumors were visible inside the interdural space and covered with the epineurium. In three cases, the tumors were completely removed, and in one case the tumor was subtotally removed with intraoperative facial monitoring. In the histological sections, we confirmed that the GPN ran within the interdural space.