**5. Postoperative care**

**Figure 7.** From the left to the right: T1 gadolinium enhanced TS. The patient underwent endoscopic transpterygoid endonasal approach for an anteromedially located trigeminal schwannoma. In the middle, postoperative CT scan, and

**Figure 6.** From the left to the right, postoperative T2-weighted image (axial) and T1 coronal with gadolinium after

5 years showing gross total resection without recidive of the tumor.

80 Brain Tumors - An Update

bone scan on the right show nuances of the approach and gross total resection of the tumor.

Early trigeminal dysfunction can be observed after surgery but usually presents progressive improvement. Trigeminal pain has significant reduction or even resolution after surgery. A complication that might occur and should be exhaustively addressed is the hypoesthesia of the ophthalmic branch of the trigeminal nerve, which may develop keratitis as the most severe complication due to decreased corneal reflux. The traction of the dura mater during the peeling of the middle fossa may lead to retraction of the major superficial petrosal nerve and even its avulsion with lesion of the geniculate ganglion, culminating in facial nerve injury. Other complications are dependent on the manipulation of the cranial nerves in contact with the tumor, in addition to cerebrospinal fluid fistula, infection, and venous infarction due to excessive retraction of the temporal lobe.

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Imeni N. N. Burdenko. 2014;**78**:23-32

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