An algorithm for treating extracranial head and neck schwannomas

Abstract

Surgical resection of extracranial head and neck schwannomas (ECHNS) may be associated with major morbidity, but some ECHNSs can be safely treated expectantly. The aim of this study is to present a large case series and an algorithm for therapeutic decision-making in the management of ECHNS. The clinical records of patients diagnosed and treated for ECHNS between 1999 and 2012 at The Tel Aviv Sourasky Medical Center were reviewed retrospectively. All relevant demographic and medical data were extracted, among them presenting symptoms, surgical approaches, nerve of origin, complications and follow-up. A total of 53 patients with ECHNS were included in this clinical study. There were 29 males and 24 females whose mean age was 49.2 years, and all were treated surgically. The schwannomas originated from the brachial plexus, sympathetic chain, vagus nerve, trigeminal nerve, lip, hypoglossal nerve and larynx. Intracapsular enucleation was performed in 32 (60 %) patients, and the remaining 21 (40 %) patients underwent complete excision of the tumor with the involved nerve segment. Thirty-two patients (60 %) had postoperative neurological deficits. This study provides an algorithm to serve as a guideline in the decision-making process for this patient population. Although there is abundant evidence regarding the efficacy of radiotherapy for acoustic schwannoma, the value of radiotherapy as a treatment alternative for patients with ECNHS, especially those unsuitable for surgery, has not been established and further studies are warranted.

A Rare Schwannoma Of The Submandibular Gland: A Case Report

“…Schwannomas are growing, solitary neoplasms of Schwann cell origin. In the head and neck region they occur most commonly in the internal acoustic meatus, with most of them were benign schwannomas, with only one was reported as malignant schwannoma 4 In our patient, FNAC was not helpful for diagnosis, and we believe FNAC guided by ultrasound is needed for a more informative cytology, as has been reported with other cases 7,8 . The pattern on and MR images shows more of myxomatous tissue which raise a possibility of it not being a simple benign tumour 8,9 Treatment should be confined to complete surgical excision, and wide excision is not recommended.…”

“…Although schwannomas can arise from any nerve in the body, the most common locations include the head and neck area, contributed nearly 45% 3 . Schwannomas of the submandibular gland are rare causes of extracranial neurogenic tumours 4 . These tumors rarely shows rapid progression.…”

Extracranial head and neck schwannomas: A series of 14 patients

“…[11,13] Extracranial head and neck schwannomas ineligible for surgical treatment should be considered for radiotherapy. [17] Recent data supports radiotherapy in schwannomas originating from cranial nerves III-VI for nonsurgical candidates resulting in local control rate of 90-100%. [19,20] Close follow-up is mandatory.…”

“…[8,11,17,18] Yafit et al [17] defined a management algorithm for ECHNS. According to this algorithm, "being symptomatic" is the principal determinant in the transition from observation to treatment.…”

Submandibular schwannoma: is excision a ‘gold standard treatment’?

“…Schwannomas of the submandibular gland are rare causes of extracranial neurogenic tumours 1. Twenty-five per cent of extracranial tumours occur in the head and neck region, with 1% occurring in the intraoral region 2.…”