Experience of head and neck extracranial schwannomas in a whole population-based single-center patient series.

Due to their rarity most of the literature concerning head and neck extracranial schwannomas consists of case reports and small patient series. The aim of the study was to describe population-based incidence, presenting signs and symptoms, management and outcome of head and neck extracranial schwannomas in a larger patient group. All the head and neck extracranial schwannoma patients managed during 1987-2008 at the Helsinki University Central Hospital with a referral area of 1.5 million inhabitants were searched. Altogether 47 patients were identified and subjected to retrospective chart review. Population-based incidence of head and neck extracranial schwannomas was 0.14/100,000/year. Eighty-eight percent of the patients had symptoms, which had lasted on average for 11.5 months prior to diagnosis. Presenting signs and symptoms were diverse depending on the affected nerve. Ninety-four percent of the patients were treated surgically. Sixty-four percent of the operations were macroscopically radical. The tumor capsule was intentionally left in place in 9 %. Surgery-related complications were detected in only 7 % of the patients, but 1 month postoperatively 52 % of them had symptoms, majority relating to different nerve deficits. Treatment of extracranial head and neck schwannomas remains challenging. The tumor is benign, and it grows slowly in a vast majority of cases, but its symptoms are highly variable. Correct timing of surgery is essential, as also patients who are preoperatively asymptomatic may suffer severe postoperative morbidity. Preoperative patient counseling needs to address the risks of neurological sequelae.