Endoscopic Endonasal Surgery of a Large Vidian Nerve Schwannoma With Preparation for Avoiding Major Vascular Injury

Vidian nerve schwannomas are extremely rare, and their surgical management requires an awareness of the surrounding vascular and nervous systems, including the internal carotid artery. Herein, we report a case of a vidian nerve schwannoma that was successfully removed using an endoscopic endonasal approach in a 21-year-old patient who presented with lacrimal hyposecretion. Imaging revealed a large mass extending to the middle cranial fossa posteriorly, to the pterygopalatine fossa laterally, and to the sphenoid sinus medially. The paraclival and petrosal portions of the internal carotid artery were displaced posteriorly. Endoscopic observation of the right nose demonstrated anterior displacement of the inferior portion of the middle turbinate. Based on the above, we suspected a vidian nerve schwannoma, and endoscopic endonasal surgery was performed with particular attention to avoid vascular injuries. An endoscopic transmaxillary approach was used to expose the anterior surface of the tumor. After confirming the pathological diagnosis intraoperatively, intracapsular resection of the tumor was completed using an ultrasonic surgical aspirator with Doppler monitoring of the location of the internal carotid artery. Endoscopic management of the surgical field and preparation to avoid vascular injury are essential for safe and efficient tumor resection.