Endoscopic Prelacrimal Approach and Modified Endoscopic Denker’s Approach to the Middle Cranial Fossa

Trigeminal schwannomas are rare benign tumors comprising about 0.36% of all intracranial neoplasms. When extending from the middle to posterior cranial fossae and extracranial spaces, such as the pterygopalatine fossa, surgical access is challenging. We report a 55-year-old female with an 8-year history of right facial tingling, numbness, and paresthesia that worsened progressively over the past year. Magnetic resonance imaging (MRI) revealed a trigeminal schwannoma involving the right middle and posterior cranial fossae, porus trigeminus, and pterygopalatine fossa. The tumor was successfully resected using an expanded endoscopic endonasal approach combining the prelacrimal and modified endoscopic Denker’s approaches. Gross total resection was achieved without neurological deficits. Preservation of the nasolacrimal duct and piriform aperture minimized postoperative complications such as epiphora, alar collapse, and retraction. The patient recovered well with significant symptomatic improvement and no recurrence at follow-up. This case illustrates the efficacy of integrating prelacrimal and modified Denker’s approaches for complex skull base tumors.