Mykayla L Sandler1, John R Sims2, Catherine Sinclair2, Kayvon F Sharif1, Rebecca Ho1, Lauren E Yue1, Maria J Téllez3, Sedat Ulkatan3, Azita S Khorsandi4, Margaret Brandwein-Weber5, Mark L Urken1,2. 1. THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York. 2. Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York. 3. Department of Intraoperative Neurophysiology, Mount Sinai West Hospital, New York, New York. 4. Department of Radiology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York. 5. Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York.
Abstract
BACKGROUND: Schwannomas, benign tumors arising from neurolemmocytes, are the most common type of peripheral nerve tumors. Extracranial schwannomas are most often found in the parapharyngeal space, commonly involving the vagus nerve to cervical sympathetic trunk. Vagal schwannomas present several unique clinical and therapeutic challenges. METHODS: A comprehensive literature review was conducted on 197 articles reporting 235 cases of cervical vagal schwannomas. Presenting symptoms, treatment approach, and postoperative outcomes were recorded and analyzed. RESULTS: Vagal schwannomas commonly present as asymptomatic neck masses. When they become symptomatic, surgical resection is the standard of care. Gross total resection is associated with higher postoperative morbidity compared to subtotal resection. Initial reports using intraoperative nerve monitoring have shown improved nerve preservation. Recurrence rates are low. CONCLUSION: The combination of intermittent nerve mapping with novel continuous vagal nerve monitoring techniques may reduce postoperative morbidity and could represent the future standard of care for vagal schwannoma treatment.
BACKGROUND:Schwannomas, benign tumors arising from neurolemmocytes, are the most common type of peripheral nerve tumors. Extracranial schwannomas are most often found in the parapharyngeal space, commonly involving the vagus nerve to cervical sympathetic trunk. Vagal schwannomas present several unique clinical and therapeutic challenges. METHODS: A comprehensive literature review was conducted on 197 articles reporting 235 cases of cervical vagal schwannomas. Presenting symptoms, treatment approach, and postoperative outcomes were recorded and analyzed. RESULTS:Vagal schwannomas commonly present as asymptomatic neck masses. When they become symptomatic, surgical resection is the standard of care. Gross total resection is associated with higher postoperative morbidity compared to subtotal resection. Initial reports using intraoperative nerve monitoring have shown improved nerve preservation. Recurrence rates are low. CONCLUSION: The combination of intermittent nerve mapping with novel continuous vagal nerve monitoring techniques may reduce postoperative morbidity and could represent the future standard of care for vagal schwannoma treatment.
Authors: Carlos Suárez; Fernando López; William M Mendenhall; Simon Andreasen; Lauge Hjorth Mikkelsen; Johannes A Langendijk; Stefano Bondi; Juan P Rodrigo; Leif Bäck; Antti A Mäkitie; Verónica Fernández-Alvarez; Andrés Coca-Pelaz; Robert Smee; Alessandra Rinaldo; Alfio Ferlito Journal: Cancer Manag Res Date: 2021-01-18 Impact factor: 3.989