Schwannoma in Head and Neck: Preoperative Imaging Study and Intracapsular Enucleation for Functional Nerve Preservation

PURPOSE: In treating schwannoma patients, it is critical to determine the origin of the tumor to preserve nerve function. We evaluated the validity of preoperative imaging studies in distinguishing the neurological origin of the schwannomas of the head and neck, and the efficacy of intracapsular enucleation in preserving nerve function. MATERIALS AND METHODS: In 7 cases of schwannomas in the head and neck region, we predicted whether the tumor originated from the vagus nerve or the cervical sympathetic chain through imaging studies including computed tomography (CT) and magnetic resonance imaging (MRI). All patients were performed intracapsular enucleation, and the function of the vagus nerve and the sympathetic nerve was evaluated preoperatively and postoperatively. RESULTS: Preoperative imaging studies showed 6 cases where the tumor was located between the carotid artery and the internal jugular vein, and 1 case where the tumor was located posteriorly, displacing the carotid artery and the internal jugular vein anteriorly. At the time of operation, we confirmed schwannoma originating from the vagus nerve on the first 6 cases, and schwannoma originating from the sympathetic nervous system on the last case. All patients went through successful intracapsular enucleation, and of the seven schwannoma cases, 6 patients maintained normal postoperative neurological function (85.7%). CONCLUSION: Preoperative imaging studies offer valuable information regarding the location and origination of the tumor, and intracapsular enucleation helped us to preserve the nerve function.

A Case of Fibrous Dysplasia Simultaneously Involving the Sphenoid Sinus and the Clivus

Fibrous dysplasia is an uncommon benign bone disorder in which normal medullary bone is replaced by fibrotic and osseous tissue. Limited involvement of the sphenoid sinus or the clivus is extremely unusual. Here, we present a case of fibrous dysplasia in a 46-year-old female that involved the sphenoid sinus and the clivus simultaneously. Imaging modalities demonstrated an expansile lesion filling the entire left sphenoid sinus, extending to the clivus. Biopsy specimen was obtained by endoscopic sphenoid sinusotomy, and it showed extensive spindle-shaped fibroblastic cells with irregularly shaped trabeculae of woven bone which was compatible with fibrous dysplasia. After 6-month follow-up, the patient displayed no evidence of recurrence.