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Case Reports
. 2018 Mar 4:2018:4074905.
doi: 10.1155/2018/4074905. eCollection 2018.

Head and Neck Schwannomas: A Surgical Challenge-A Series of 5 Cases

Ishtyaque Ansari  1 , Ashfaque Ansari  2 , Arjun Antony Graison  2 , Anuradha J Patil  3 , Hitendra Joshi  2
Affiliations
Case Reports

Head and Neck Schwannomas: A Surgical Challenge-A Series of 5 Cases

Ishtyaque Ansari et al. Case Rep Otolaryngol. .

Abstract

Background: Schwannomas, also known as neurilemmomas, are benign peripheral nerve sheath tumors. They originate from any nerve covered with schwann cell sheath. Schwannomas constitute 25-45% of tumors of the head and neck. About 4% of head and neck schwannomas present as a sinonasal schwannoma. Brachial plexus schwannoma constitute only about 5% of schwannomas. Cervical vagal schwannomas constitute about 2-5% of neurogenic tumors.

Methods: We present a case series of 5 patients of schwannomas, one arising from the maxillary branch of trigeminal nerve in the maxillary sinus, second arising from the brachial plexus, third arising from the cervical vagus, and two arising from cervical spinal nerves.

Result: Complete extracapsular excision of the tumors was achieved by microneurosurgical technique with preservation of nerve of origin in all except one.

Conclusion: Head and neck schwannoma though rare should be considered as a differential diagnosis of a unilateral slow growing mass in the head and neck region, particularly in an adult. Schwannomas are always a diagnostic dilemma as they are asymptomatic for long time, and histopathology is the gold standard for diagnosis. As a rule, treatment is surgical and dictated by the location of the tumor and nerve of origin. Due to its rarity, complex anatomical location and morbidity risk postexcision, they can pose a formidable challenge to surgeons. This study aims to describe the presentation, workup, surgical technique, and outcome.

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Figures

Figure 1
Figure 1
(a) Preoperative CT showing the tumor (∗) present in the posterior part of the left maxillary sinus and the left nostril. (b) Postoperative CT.
Figure 2
Figure 2
(a) Intraoperative picture. (b) Postoperative 3DCT reconstruction: orbital floor and maxilla reconstruction done with titanium mesh and plate.
Figure 3
Figure 3
Pre-op image (arrows indicating tumor).
Figure 4
Figure 4
(a) T2-weighted coronal cut. (b) T1-weighted coronal cut. (c) T2-weighted axial cut. (d) Postcontrast T1 sagittal cut.
Figure 5
Figure 5
(a) Tumor with nerve attachment. (b) Enucleated tumor with intact capsule.
Figure 6
Figure 6
Neck mass (arrows).
Figure 7
Figure 7
(a) Intra-op tumor excision. (b) Showing the tumor nerve attachment. (c) Enucleated tumor with intact innermost layer of capsule. (d) Vagus reanastomosis using sural nerve graft.
Figure 8
Figure 8
(a) MRI angiography showing splaying of the carotids by the tumor. (b) T2-weighted coronal cut. (c) T2-weighted axial cut. (d) Postcontrast T1 sagittal cut.
Figure 9
Figure 9
(a) Intraoperative tumor excision. (b) Enucleated tumor with intact innermost layer of capsule.
Figure 10
Figure 10
(a) T2-weighted coronal cut. (b) T2-weighted axial cut. (c) Postcontrast T1-weighted sagittal cut.
Figure 11
Figure 11
(a) Schwannoma under high power resolution (H&E stain 40x). (b) Schwannoma under low power resolution (H&E stain 10x).
Figure 12
Figure 12
Technique of extracapsular excision.
See this image and copyright information in PMC

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