Schwannomas in the head and neck: retrospective analysis of 21 patients and review of the literature

Abstract

CONTEXT AND OBJECTIVE: Schwannomas are benign neoplasms of the peripheral nerves originating in the Schwann cells. According to their cellularity, they can be subdivided into Antoni A or Antoni B types. They are rare and usually solitary, with clearly delimited capsules. They occur in the head and neck region in only 25% of the cases, and may be associated with Von Recklinghausen's disease. The present study retrospectively analyzed some data on this disease in the head and neck region and reviewed the literature on the subject. DESIGN AND SETTING: Retrospective study at Head and Neck Service, Universidade Estadual de Campinas. METHODS: Data on 21 patients between 1980 and 2003 were reviewed. The sites of cervical schwannomas and the intraoperative, histopathological and postoperative clinical status of these cases were studied. Diagnostic methods, type of surgery and association with neurofibromatosis were evaluated. RESULTS: The patients' ages ranged from 16 to 72 years. Four patients had a positive past history of type I neurofibromatosis or Von Recklinghausen's disease. The nerves affected included the brachial and cervical plexuses, vagus nerve, sympathetic chain and lingual or recurrent laryngeal nerve. The nerve of origin was not identified in six cases. Tumor enucleation was performed in 16 patients; the other five required more extensive surgery. CONCLUSION: Schwannomas and neurofibromas both derive from Schwann cells, but are different entities. They are solitary lesions, except in Von Recklinghausen's disease. They are generally benign, and rarely recur. The recommended surgical treatment is tumor enucleation.

Hypoglossal Schwannoma of Parapharyngeal Space: An Unusual Case Report

“…Approximately 25-45% of the cases occur in the head and neck region and are sometimes (8-19%) associated with Neurofibromatosis type-1 (NF-1) [7,8]. They are found on the face, scalp, intracranial cavity, orbit, oral and nasal cavities, parapharyngeal space, middle ear, larynx, and medial and lateral regions of the neck.…”

“…Schwannomas of the parapharyngeal space usually occur between the ages of 30 and 70 years [6] with greatest incidence in third to fifth decades [8]. Hoshi et al [11] described 85 cases of hypoglossal schwannomas in 16-85 years of age (mean 47.8).…”

“…Complete surgical excision is the treatment of choice as these tumors are radio resistant and chemotherapy has [6,8,13]. The surgical planning is influenced by the size of lesion, location, vascularity, and relation to adjacent structures like sympathetic chain, vagus nerve, carotid artery and jugular vein and other vital structures [19].…”

“…Recently, intracapsular enucleation has been introduced which preserve the nerve fibres, and there by the neurological functions [19]. Though schwannoma has been described as a benign tumor but local recurrence and malignant schwannoma has been described by Langner et al [8] in one (14.2%), out of 21 cases. Approximately 4% of malignant schwannomas has also been reported in cervical nerves [7].…”

A rare cause of forearm pain: Schwannoma of the posterior interosseoz nerve

“…Schwannomların tedavisinde kemoterapi ve radyoterapinin etkinliği sınır-lıdır. [9] Ayrıca lezyonun benign nitelikte olmasından ötürü önerilmemektedir. Gerçek kapsüllü ve düzgün yüzeyli olmaları eksizyonu kolaylaştıran etkenlerdir.…”