Cervical Schwannoma Research Articles

Surgical Strategy for Dumbbell-Shaped Cervical Schwannoma at the Vicinity of the Vertebral Artery: The Utilization of Anatomic Layer.

In cases where dumbbell-shaped cervical schwannoma encases the vertebral artery (VA), there is a risk of VA injury during surgery. The objective of this study is to propose a strategy for preserving the VA during the surgical excision of tumors adjacent to the VA through the utilization of anatomic layers. A retrospective analysis was conducted on 37 patients who underwent surgery for dumbbell-shaped cervical schwannoma with contacting VA from January 2004 to July 2023. The VA encasement group consisted of 12 patients, and the VA nonencasement group included 25 patients. The perineurium acted as a protective barrier from direct VA exposure or injury during surgery. However, in the VA encasement group, 1 patient was unable to preserve the perineurium while removing a tumor adjacent to the VA, resulting in VA injury. The patient had the intact dominant VA on the opposite side, and there were no new neurological deficits or infarctions after the surgery. Gross total resection was achieved in 25 patients (67.6%), while residual tumor was confirmed in 12 patients (32.4%). Four patients (33.3% of 12 patients) underwent reoperation because of the regrowth of the residual tumor within the neural foramen. In the case of the 8 patients (66.7% of 12 patients) whose residual tumor was located outside the neural foramen, no regrowth was observed, and there was no recurrence of the tumor within the remaining perineurium after total resection. In conclusion, when resecting a dumbbell-shaped cervical schwannoma contacting VA, subperineurium dissection prevents VA injury because the perineurium acts as a protective barrier.

A case of malignant transformation to angiosarcoma during long-term follow-up of a cervical schwannoma

A case of malignant transformation to angiosarcoma during long-term follow-up of a cervical schwannoma

Utility of sodium fluorescein in recurrent cervical vagus schwannoma surgery.

Cervical schwannoma is a rare neoplasm that usually occurs like a nondolent lateral neck mass but when growing and symptomatic requires radical excision. Sodium fluorescein (SF) is a dye that is uptake by schwannomas, which makes it amenable for its use in the resection of difficult or recurrent cases. We describe the case of a patient presenting with a recurrence of a vagus nerve schwannoma in the cervical region and the step-by-step technique for its complete microsurgical exeresis helped by the use of SF dye. We achieved a complete microsurgical exeresis, despite the presence of exuberant perilesional fibrosis, by exploiting the ability of SF to stain the schwannoma and nearby tissues. That happens due to altered vascular permeability, allowing us to better differentiate the lesion boundaries and reactive scar tissue under microscope visualization (YELLOW 560 nm filter). Recurrent cervical schwannoma might represent a surgical challenge due to its relation to the nerve, main cervical vessels, and the scar tissue encompassing the lesion. Although SF can cross both blood-brain and blood-tumor barriers, the impregnation of neoplastic tissue is still greater than that of nonneoplastic peripheric tissues. Such behavior may facilitate a safer removal of this kind of lesion while respecting contiguous anatomical structures.

Minimally invasive resection of cervical schwannoma (C1-C2 level) using tubular retractors.

Cervical schwannoma excision usually involves laminectomy and violation of the facet joints that necessitates the need for fusion with consequent loss of cervical mobility. The authors present the first video demonstration of an excision of the cervical schwannoma at the C1-2 level using minimally invasive spine tubular retractors, which allows direct access to the lesion and prevents the need for any bony removal. It also preserves the paraspinal muscles, which are important for spinal stability, especially at the C2 level. Special attention is given to incision planning and preoperative image analysis for preventing injury to critical neurovascular structures at this level.

Cervical schwannoma: diagnosis and treatment

Schwannomas are benign, encapsulated, slow-growing, tumours deriving from the peri neural cells located in the nerve sheath. They can arise from any cranial, peripheral or autonomic nerves, and show a predilection for the head and neck region. They may produce secondary symptoms like nasal obstruction, dysphagia, and hoarseness of voice depending upon the location of the tumour. Preoperative diagnosis is difficult, relying on clinical suspicion, and confirmed by surgical pathology. Preoperative imaging or fine needle aspiration cytology may help to reveal diagnosis. The definitive diagnosis is made by histopathological examinations. A 28 years old female patient presented to the OPD with painless swelling on the left lateral side of the neck since 1 year. The swelling was mobile, non-tender, non-pulsatile firm in consistency measuring 4×3 cm with no bruit. MRI neck with contrast was done which revealed a moderately enhancing lesion of size 7×4×3 cm in the left carotid sheath. The tumour was approached by an anterior approach along the medial border of the sternocleidomastoid. Platysma and fascia were dissected followed by carotid sheath to reach the tumour. As the mass was seen arising from a branch of the ansa cervicalis, it had to be sacrificed.

A Case of Glossopharyngeal Schwannoma Protruding to the Larynx: A Case Report

Schwannoma is benign tumor that can occur in any part of the nerve that contains a Schwann cell. It is rare in the head and neck region and is characterized by common postoperative neurologic symptoms. We experienced a cervical schwannoma in a 22-year-old young man. Except for a foreign body sensation in the neck and a mass in the anterior region, there were no other complaints. A retropharyngeal schwannoma was most suspected considering neck computed tomography, magnetic resonance imaging, laryngoscopy and fine needle aspiration. Surgical treatment was performed, and the origin of the schwannoma was diagnosed as the tonsillar branch of the glossopharyngeal nerve. Histopathological examination confirmed the presence of a schwannoma with typical characteristics. After surgery, the patient recovered without any side effects. We report this case with a review of the literature.

CAROTID SPACE TUMOUR – SCHWANNOMA

The cervical schwannoma is very rare but benign mass lesion. It often results in nonspecic clinical presentations requiring surgical ablation. Surgical indications should be based carefully on the balance between risks and benets. Intracapsular enucleation seems to give good results without much complications and recurrence is rare. Reporting case of schwannoma which at rst stance seems to be having features of typical carotid body tumour but on histopathology it is seen as Schwann cell tumour arising in left carotid space

Surgical management of spinal schwannomas arising from the first and second cervical roots: Results of a cumulative case series.

Schwannomas of the first and second nerve roots are rare neurosurgical entities, harboring specific surgical features that make surgical resection particularly challenging and deserve specifics dissertations. This study is a retrospectively analysis of 14 patients operated in two different neurosurgical centers: the San Filippo Neri Hospital of Rome and the Federal Centre of Neurosurgery of Tjumen. In the last 6 years, 14 patients underwent neurosurgical resection of high cervical (C1-C2) schwannomas, in two different neurosurgical centers. Patients data regarding clinical presentation, radiological findings, and surgical results were retrospectively analyzed. The mean age was 50 years (range 13-74), the follow-up mean duration was 30 ± 8.5 (range 24-72 months), and there was no significant differences among different tumor locations (intradural, extradural, and dumbbell). Surgical results were excellent: gross total resection was achieved in all cases and there were no intraoperative complications or postoperative mortality. All patients presented postoperative clinical improvement except one who remained stable. Karnofsky performance status, at the last follow-up, confirmed a global clinical improvement. No vertebral artery (VA) injury neither spinal instability occurred; nerve root sacrifice was reported in one case. Neurosurgical treatment of C1-C2 schwannomas is associated with good outcomes in terms of extent of resection and neurological function. In particular, dumbbell shape and VA involvement do not represent limitations to achieve complete tumor resection and good clinical outcome. In conclusion, microsurgery represents the treatment of choice for C1-C2 schwannomas.

Giant Spinal Schwannomas. Presentation of Two Cases with Interdisciplinary Surgical Resection

Purpose: To report two quite rare cases of giant schwannomas of the cervical and thoracic spine. Surgical resection is usually the treatment of choice for these neoplasms. Methods: The first patient is a 48-year-old male that came to our department, complaining about weakness and paresthesia of both lower extremities and upper left extremity, and a considerably big dorsal palpable lump. MRI and CT scan were used to diagnose giant cervical schwannoma. Because of the intensity of symptoms, he was subjected to surgery. Multidisciplinary resection involving neurosurgical and oncosurgicalteamn was performed for intravertebral and extravertebral approaches. The second patient is a 55-year-old female that came to the hospital complaining about incapacitating pain and dysesthesia involving T6, T7, and T8 dermatomes, with no other deficits. MRI and CT scan were used to diagnose giant thoracic schwannoma. Because of the intensity of the pain, surgery was decided as the treatment of choice. Video assisted thoracoscopic surgery was performed and total resection was achieved, with improvement of the symptoms. Results: Both patients showed complete remission of the symptoms, with no major deficits after surgery. Conclusion: Although infrequent, giant spinal schwannomas may be the cause of visible lumps in the back with radicular symptoms. When asymptomatic, conservative treatment could be viable, but when they present symptoms, surgery offers good results.

Review of Cervical Schwannomas: Presentation, Pathogenesis, Management, Complications and Future Directions.

Cervical schwannomas are benign peripheral nerve sheath tumors, relatively uncommon pathologies. The purpose of this review is to summarize and expand on the existing literature on cervical schwannomas, focusing on clinical presentation, pathogenesis, surgical and radiologic management and innovative therapies including ultrasound-guided techniques. Pubmed and SCOPUS databases were searched using combinations of terms including "cervical schwannoma", "surgery", "fusion", "complications", "radiosurgery", and others. The findings regarding these unique clinical entities are presented below.

Type-II Neurofibromatosis with Cervical Schwannoma Posted for Emergency Lower Segment Cesarean Section under Sole Epidural Technique

Type-II Neurofibromatosis with Cervical Schwannoma Posted for Emergency Lower Segment Cesarean Section under Sole Epidural Technique

Giant Inflammatory Cervical Ganglion Due to Ectopic Rib Head: Report of a Rare Diagnosis Mimicking a Cervical Schwannoma

Cervical schwannomas may be common in patients with cervicobrachialgia. We report a case of an apparent C8 schwannoma in a 55-year-old female that was discovered to be an inflammatory enlarged cervical ganglion. Such a rare presentation may be explained by the particular conformation of the left C7-Th1 neuroforamen, compressed by an ectopic cranially located first rib head, which was visible only with a cervical computed tomography scan. No similar finding is reported in the literature, and this interesting case may provide new insight into the differential diagnosis of cervical spinal lesions.

Clinical Effect of Laminectomy with Lateral Mass Screw Fixation in Treating Cervical Schwannoma: A Retrospective Study.

Background The objective of this study was to evaluate the clinical effectiveness and safety of laminectomy combined with lateral mass screw fixation in treating cervical intradural extramedullary schwannoma. Methods We retrospectively collected and analyzed medical records of 38 patients who underwent resection of cervical intraspinal schwannoma between January 2012 and April 2019. Based on different surgical procedures, two groups were divided among all participants: laminectomy-only (n = 21) and laminectomy with instrumented fixation (n = 17); the minimum follow-up time was 1 year. The visual analogue scale (VAS) score and neck disability index (NDI) were utilized for pain assessment; the Japanese Orthopedic Association (JOA) score was carried out for the assessment of neurological impairment. Radiographic changes of Cobb angle were compared before and after the surgery. Results Consequently, demographics were well matched in both groups, without any statistical difference (P > 0.05). Compared with preoperation, both surgical procedures significantly improved VAS, NDI, and JOA scores (P < 0.001), but no differences between them (P > 0.05). In terms of postoperative spinal instability/deformity, laminectomy-only caused more events than instrumented fixation, which is statistically significant (P < 0.001). Conclusions In summary, laminectomy with lateral mass screw fixation is an effective and safe approach to treat cervical intraspinal schwannoma, which is likely to be a better choice than the laminectomy-only approach.

Case Report: Rare Case of NF2 in Pregnancy with Favorable Maternal and Perinatal Outcome, Under General Anesthesia Caesarean Section

Background: Neurofibromatosis type 2 (NF2) is an autosomal dominant disease due to chromosome 22 (22q12.2) mutation with a prevalence of 1:33,000-40,000. As many as 50% of cases are familial, 30-60% are genetic mosaic, de novo mutations. Tumor growth in NF often becomes more rapid in pregnancy. Pregnancy with NF2 has a risk of complications of hypertension, preeclampsia, cardiovascular problems, and IUGR (Intrauterine growth restriction). Case Reports: A 26-year-old woman, 29/30 weeks gestational age complaint of visual impairment, hearing loss, and multiple body masses. The results of MRI examination of the Head and whole Spine with contrast showed bilateral vestibular schwannoma, meningiomatosis, cervical schwannoma (C1-C5), which were features of NF2. Routine clinical evaluation, laboratory tests, fetal growth examination, and multidisciplinary management were performed during the antenatal care. There were no signs of increased intracranial pressure, hydrocephalus, and complications of preeclampsia, fetal abnormalities, or IUGR. A termination at 37 weeks of gestation with Caesarean Section and General Anesthesia was decided to reduce the increase of intracranial pressure during labor. A male infant was born with a birth weight of 2600 grams, without any abnormalities. Conclusion: Pregnancy in NF2 patient has a potential risk of tumor growth progression, preeclampsia, and IUGR, therefore it is necessary to monitor and evaluate the mother and fetus multidisciplinary during the pregnancy process to get good maternal and fetal outcomes. The mode of delivery in neurofibromatosis is determined mainly by obstetric indications.

Intracapsular enucleation of cervical schwannomas via retroauricular hairline incision

IntroductionCervical schwannomas are rare diseases treated by complete resection, leading to potential neurological deficits. Intracapsular enucleation is an acceptable alternative to preserve the involved nerve function, but the clinical outcomes by an aesthetically pleasing approach remain unrevealed. This study evaluated functional and oncological outcomes after intracapsular enucleation of cervical schwannomas via retroauricular hairline (Roh's) incision. Materials and methodsThis prospective observational study included 17 patients with cervical schwannomas who underwent intracapsular enucleation to preserve the involved nerve and capsule via Roh's incision. Each patient was evaluated with any complications, nerve function, subjective satisfaction, voice and swallowing questionnaires, and local recurrence. ResultsIntracapsular enucleation via the Roh's incision was successfully applied to all patients for a median operation time of 48 min. Tumours of 4.5-cm median size were removed with the minimization of injury to the nerve and sheath deflected on the surface of the tumour. Temporary and permanent paralysis of the unilateral vocal fold was found in 3 (33%) and none of 9 patients with vagal schwannomas, respectively. Horner's syndrome occurred temporarily in two of 5 (40%) patients with sympathetic chain schwannomas. Postoperative complications were minor. Subjective satisfaction of scar and facial deformity was high, and subjective voice and swallowing difficulties were minimal one year after surgery. No recurrence was found in the patients for a median follow-up of 82 months. ConclusionIntracapsular enucleation via Roh's incision is a viable treatment for cervical schwannomas with the highest functional, cosmetic, and oncological outcomes.

Extracranial Head and Neck Schwannomas: A Case Series and Review of Literature.

Schwannomas are benign nerve tumors of schwann cell origin. Schwann cells are derived from neural crest and are therefore of neuroectodermal origin. 25-40% of all schwannomas arise in the head and neck region. The most common schwannomas are vagal schwannomas and cervical schwannomas in the head and neck region. Here we present two cases of head and neck schwannomas which were not identified as originating from any major nerve. The first patient had a schwannoma in the infratemporal region which was excised by performing transzygomatic approach, and the second patient had a schwannoma in the left lateral part of the neck which was excised using a cervical crease incision.

How I Do It: endoscope-assisted resection of a large dumbbell-shaped cervical schwannoma.

Cervical dumbbell-shaped schwannomas are often challenging in terms of complete resection. There are few reports on the use of endoscope-assisted surgery for foraminal schwannomas. We used the wide-angle endoscope to assist in resecting a large cervical 3-4 dumbbell-shaped schwannoma. The well-designed set-up allowed the surgeon to achieve easier manipulation ins a straight surgical trajectory with minimal intraoperative adjustment. The endoscope allowed surgeons to visualize and operate in regions beyond the straight line of sight, without the need for facetectomy and subdural inspection. We believe that this case demonstrates the feasibility of applying endoscope-assisted surgery for large cervical dumbbell-shaped schwannomas.

A Study on Surgical Results of Cervical Sympathetic Chain Schwannoma

A Study on Surgical Results of Cervical Sympathetic Chain Schwannoma

Far Lateral Approaches: Far Lateral Approach With Minimal Condylectomy for C2 Schwannoma: 3-Dimensional Operative Video

Upper cervical schwannomas are rare lesions and together with meningiomas constitute around 5% of spinal tumors. The approach to these lesions is difficult because of the close proximity of the medulla and cervical spinal cord, lower cranial nerves, and the vertebral artery. Schwannomas in the upper cervical area typically arise from the dorsal roots and are located posterior to the dentate ligament. Nevertheless, a far lateral approach is often required for these lesions because of their lateral extent through the neural foramen and the proximity of both the V3 and V4 segments of the vertebral artery. With these lesions, an extensive condylectomy is rarely required. We present a case of a 40-yr-old woman who presented with an 8-mo history of deteriorating mobility and feeling of heaviness in the lower limbs with a further acute deterioration 1 wk before admission. She had a dissociated sensory loss and myelopathy in keeping with a partial hemicord syndrome. Imaging revealed a right-sided C2 intradural lesion extending through the C2 foramen in keeping with a C2 schwannoma. The patient was counseled on the treatment options, and informed consent for surgery was obtained. We describe a right-sided far lateral approach with minimal condylectomy for gross total resection of this lesion. We demonstrate the relationship of the tumor with the C2 nerve root, the spinal accessory nerve, and the cervical cord. We supplement the discussion with a 3D surgical video.

Cervical Schwannoma of the Vagus Nerve: Systematic Review and Two Illustrative Cases

Background: Cervical schwannoma is a rare and benign tumor exclusively developed from the cell of Schwann that rarely involve the vagus nerve. Methods: We have conducted a retrospective review with strategy of the consulted references and database included articles published in Portuguese, English and French in PUBMED, MEDLINE, EMBASE, LILACS and SciELO, since 1936 until the present day, associated with a description of two illustrative cases. Both patients presented with a history of painless palpable mass in the cervical region. Results: About 160 cases has been described in literature. Most cases of manifest between the third and sixth decades of the patient's life as a slow growing firm, painless mass in the lateral neck. Imaging is essential to management. Histopathological examination can reveals encapsulated, biphasic spindle cell neoplasia. The best choice of treatment for this type of tumor is complete surgical removal with preservation of the vagus nerve by means of intracapsular resection. In both ilustrative cases the lesions were diagnosed by means of imaging studies and were totally ressected. Surgical findings and histopathology confirmed the diagnosis of vagus nerve schwannoma. There was no recurrence at five years of follow-up. In one case there was disphonya that solved within six months after the surgery. Conclusion: Vagus nerve schwannomas are rare benign tumors. The enucleation technique is used to obtain the most functional preservation and complete excision without permanent deficit is possible even with the occurrence of large lesions.