Author(s)
Valentina Montanez Azcarate, MD
Alexandra Scheiflinger, MD
Alexa Kacin, MD
Scharukh Jalisi, MD MBA FACS
Affiliation(s)
Beth Israel Deaconess Medical Center;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to recognize the clinical presentation of extracranial head and neck schwannomas, possible nerves of origin, surgical strategies and potential postoperative consequences.
Objectives: Cervical schwannomas present unique challenges in surgical management due to their location and relationship with critical structures of the head and neck. We described our experience with 11 cervical schwannomas cases, detailing their clinical presentation, tumor characteristics, surgical interventions, and outcomes.
Study Design: Retrospective case series.
Methods: We reviewed medical records from 2017 to 2024 to identify patients with confirmed or suspected cervical schwannomas treated at a tertiary care hospital by the head and neck surgery department. Collected data included demographic information, surgical technique, tumor characteristics, and postoperative outcomes.
Results: 11 patients (five women and six men, ages 27-74) were diagnosed with extracranial head and neck schwannomas. Most tumors (8) were right sided, presenting with a neck mass and with largest diameters ranging from 13 to 87 mm. The nerves of origin were sympathetic chain (2), brachial plexus (2), facial nerve (2), cervical plexus (1), vagus nerve (1), vagus and glossopharyngeal nerve (1), recurrent laryngeal nerve (1), and spinal accessory nerve (1). Nine patients opted for surgical intervention, one chose to observe until tumor progression, and one remained under observation with imaging. Extracapsular resection (ER) was performed in eight cases, nerve sacrifice needed in three of them (recurrent laryngeal nerve, facial nerve, spinal accessory nerve), resulting in vocal cord and facial paralysis. Of the five patients who underwent ER without nerve sacrifice, one experienced postoperative dysphagia. Intracapsular resection (IR) was performed in two cases, with one patient experiencing Horner syndrome and vocal cord paralysis afterward. No recurrences have been reported in any of the cases to date.
Conclusions: Extracranial head and neck schwannomas are rare tumors that present with a variety of symptoms. Both IR and ER are viable surgical options that carry their risks, with outcomes influenced by the tumor's extent and structures involved. Continuous monitoring is essential to manage potential long term complications and prevent recurrence.