Expanded endoscopic endonasal transpterygoid transmaxillary approach for a giant trigeminal schwannoma Rafael Martínez-Pérez, MD, PhD,1 Marcus Zachariah, MD, PhD,1 Ruychen Li, MD,1 Giuliano Silveira-Bertazzo, MD,1 Ricardo L. Carrau, MD, MBA,1,2 and Daniel M. Prevedello1,2 Departments of 1Neurosurgery and 2Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio Atypical trigeminal schwannomas (ATSs) are notorious for their ability to invade the skull base. An expanded endoscopic endonasal approach (eEEA) provides direct access to the tumor with no need for cerebral retraction or manipulation of neurovascular structures. Herein, we present a case of a large temporal fossa extradural lesion with secondary invasion of the sella, clivus, and temporal and infratemporal fossae in a 49-year-old male with severe vision loss. A transpterygoid transmaxillary approach was performed. Gross-total removal was achieved and pathology revealed the diagnosis of ATS. Visual function fully recovered in the right side and the patient has been uneventfully followed since surgery.