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.

Two Cases of Neurilemmoma of the Cervical Vagus Nerve Including IntracapsularEnucleation of Nerve Preservation / 대한이비인후과학회지

Neurilemmomas is benign tumor originating from all kinds of cranial nerve except optic nerve and olfactory nerve, spinal nerve root and peripheral nerve. It superficially resembles neoplasm of fibroblastic origin, but has distinctive histological pattern and arise from the neuroectodermal sheath of schwann. Approximately 25% to 40% of all neurilemmomas are found in the neural structure of the head and neck. The tumor mostly develops in the acoustic nerve and there are several reports of neurilemmonas originating form tongue, pharynx, lip, larynx and palate etc. However, reports of Neurilemmoma originating from cervical vagus nerve have been extremely rare. We experienced two cases neurilemmoma of cervical vagus nerve that were treated with different surgical methods. In the first case, the tumor was extirpated by sacrificing the nerve trunk and in second case, it was enucleated by preserving the neural pathway using the microsurgical technique.

Neurilemmomas of the Cervicla Vagus Nerve: A Case Report

A case of the recurrent neurilemmoma of vagus nerve in the neck is presented. It was located in the upper third of the right lateral neck. The patient was presented with hoarseness and monoparesis of the right arm. The tumor was composed of large cystic portion and solid nodule in the right carotid fossa. Since total surgical removal of the tumor could cause functional deterioration of the involved vagus nerve, it was removed by means of intracapsular enucleation. Postoperatively, the monoparesis of the right arm was disappeared with preservation of vagus nerve function. It would appear that an intracapsular enucleation may be advisible in some cases of neurilemmomas of the cervical vagus nerve to maintain the function of the involved vagus nerve.