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A Review of Microsurgical Resection of Recurrent Laryngeal Neurilemmoma Under Nerve Monitoring. J Craniofac Surg 2022; 33:e644-e647. [PMID: 35968945 DOI: 10.1097/scs.0000000000008722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Laryngeal neurilemmoma, especially recurrent laryngeal neurilemmoma, is a rare neural sheath tumor in head and neck. The most common symptom of laryngeal neurilemmoma is hoarseness or dysphonia, followed by dysphagia, dyspnea, and foreign body sensation. At present, surgical resection is the most effective treatment for this kind of tumor, thus making how to remove it become the most concerned problem of surgeons. CASE PRESENTATION On February 18, 2021, a 64-year-old male presented to our clinic with recurrent sore throat and intermittent hoarseness for 3 years. The results of electronic laryngoscope and magnetic resonance imaging showed a 25×10×21 mm well-defined tumor in the left pyriform sinus without laryngeal cartilage destruction and enlarged lymph nodes. After the initial diagnosis of recurrent laryngeal neurilemmoma, to preserve the continuity of recurrent laryngeal nerve as much as possible, the authors determine to perform anatomical resection of recurrent laryngeal neurilemmoma with operating microscope under the monitoring of recurrent laryngeal nerve function. Finally, the patient recovered completely from hoarseness during postoperative follow-up. CONCLUSION A complete diagnosis and treatment process of recurrent laryngeal neurilemmoma was presented by the case. Particularly, it shows the application of recurrent laryngeal nerve monitoring in the operation helps to protect the continuity of the recurrent laryngeal nerve, which lays a anatomical bases for the follow-up nerve repair.
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Fermi M, Serafini E, Ferri G, Alicandri-Ciufelli M, Presutti L, Mattioli F. Management of parapharyngeal space tumors with transparotid-transcervical approach: analysis of prognostic factors related with disease-control and functional outcomes. Eur Arch Otorhinolaryngol 2021; 279:2631-2639. [PMID: 34529157 DOI: 10.1007/s00405-021-07074-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/05/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Different therapeutic strategies have been developed to improve surgical and functional outcome of parapharyngeal space (PPS) neoplasms. The transparotid-transcervical approach (TTa) is a valid surgical option to manage most PPS tumors. Its short- and long-term disease control and cranial nerve (c.n.) function outcomes have not been discussed extensively. METHODS All patients who underwent TTa over a 10-year period at a tertiary academic center were retrospectively reviewed. Data about preoperative imaging, clinical presentation, tumor's size, location and histology, and postoperative oncological and functional results were registered and analyzed. RESULTS Sixty patients matched the inclusion criteria. Most of the lesions were benign (71.7%), involved the prestyloid PPS (63.3%) and measured more than 30 mm (75%). Fifty-two (86.7%) lesions were resected en-bloc. Clear margins were achieved in 91.7% of the cases, with positive margins solely associated with malignancy (p = 0.008). Post-operative c.n. function was satisfactory, with X c.n. function significantly associated with the retrostyloid location (p = .00) and neurogenic tumors (p = 0.02). Local disease-control was achieved in 96% of the cases after a median follow-up of 46 (± 19.7-82.0 IQR) months. CONCLUSIONS The TTa was safe and effective, achieving a satisfactory local control rate. Nevertheless, malignancies maintain a higher rate of positive margin due to their infiltrative nature and the complex anatomy of the PPS. In such cases, multiportal approaches might be more effective. However, post-operative c.n. function remained satisfactory, irrespective of lesions' size and histopathologic behavior. A higher X c.n. deficit rate was observed in retrostyloid and neurogenic lesions.
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Affiliation(s)
- Matteo Fermi
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Via del pozzo 71, 41124, Modena, Italy.,Department of Otorhinolaryngology Head and Neck Surgery, IRCCS Azienda Ospedaliera Universitaria di Bologna, Policlinico Sant'Orsola Malpighi, Bologna, Italy.,Department of Specialist, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | - Edoardo Serafini
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Via del pozzo 71, 41124, Modena, Italy.
| | - Gaetano Ferri
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Via del pozzo 71, 41124, Modena, Italy
| | - Matteo Alicandri-Ciufelli
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Via del pozzo 71, 41124, Modena, Italy
| | - Livio Presutti
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Via del pozzo 71, 41124, Modena, Italy.,Department of Otorhinolaryngology Head and Neck Surgery, IRCCS Azienda Ospedaliera Universitaria di Bologna, Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Francesco Mattioli
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Via del pozzo 71, 41124, Modena, Italy
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Ma L, Fei B. Comprehensive review of surgical microscopes: technology development and medical applications. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-200292VRR. [PMID: 33398948 PMCID: PMC7780882 DOI: 10.1117/1.jbo.26.1.010901] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/04/2020] [Indexed: 05/06/2023]
Abstract
SIGNIFICANCE Surgical microscopes provide adjustable magnification, bright illumination, and clear visualization of the surgical field and have been increasingly used in operating rooms. State-of-the-art surgical microscopes are integrated with various imaging modalities, such as optical coherence tomography (OCT), fluorescence imaging, and augmented reality (AR) for image-guided surgery. AIM This comprehensive review is based on the literature of over 500 papers that cover the technology development and applications of surgical microscopy over the past century. The aim of this review is threefold: (i) providing a comprehensive technical overview of surgical microscopes, (ii) providing critical references for microscope selection and system development, and (iii) providing an overview of various medical applications. APPROACH More than 500 references were collected and reviewed. A timeline of important milestones during the evolution of surgical microscope is provided in this study. An in-depth technical overview of the optical system, mechanical system, illumination, visualization, and integration with advanced imaging modalities is provided. Various medical applications of surgical microscopes in neurosurgery and spine surgery, ophthalmic surgery, ear-nose-throat (ENT) surgery, endodontics, and plastic and reconstructive surgery are described. RESULTS Surgical microscopy has been significantly advanced in the technical aspects of high-end optics, bright and shadow-free illumination, stable and flexible mechanical design, and versatile visualization. New imaging modalities, such as hyperspectral imaging, OCT, fluorescence imaging, photoacoustic microscopy, and laser speckle contrast imaging, are being integrated with surgical microscopes. Advanced visualization and AR are being added to surgical microscopes as new features that are changing clinical practices in the operating room. CONCLUSIONS The combination of new imaging technologies and surgical microscopy will enable surgeons to perform challenging procedures and improve surgical outcomes. With advanced visualization and improved ergonomics, the surgical microscope has become a powerful tool in neurosurgery, spinal, ENT, ophthalmic, plastic and reconstructive surgeries.
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Affiliation(s)
- Ling Ma
- University of Texas at Dallas, Department of Bioengineering, Richardson, Texas, United States
| | - Baowei Fei
- University of Texas at Dallas, Department of Bioengineering, Richardson, Texas, United States
- University of Texas Southwestern Medical Center, Department of Radiology, Dallas, Texas, United States
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4
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Sandler ML, Sims JR, Sinclair C, Ho R, Yue LE, Téllez MJ, Ulkatan S, Khorsandi AS, Brandwein‐Weber M, Urken ML. A novel approach to neurologic function sparing surgical management of vagal schwannomas: Continuous intraoperative nerve monitoring of the laryngeal adductor reflex. Head Neck 2019; 41:E146-E152. [DOI: 10.1002/hed.25793] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/23/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - John R. Sims
- Department of Otolaryngology—Head and Neck SurgeryIcahn School of Medicine at Mount Sinai New York New York
| | - Catherine Sinclair
- Department of Otolaryngology—Head and Neck SurgeryIcahn School of Medicine at Mount Sinai New York New York
| | - Rebecca Ho
- THANC (Thyroid, Head and Neck Cancer) Foundation New York New York
| | - Lauren E. Yue
- THANC (Thyroid, Head and Neck Cancer) Foundation New York New York
| | - Maria J. Téllez
- Department of Intraoperative NeurophysiologyMount Sinai West Hospital New York New York
| | - Sedat Ulkatan
- Department of Intraoperative NeurophysiologyMount Sinai West Hospital New York New York
| | - Azita S. Khorsandi
- Department of RadiologyNew York Eye & Ear Infirmary of Mount Sinai New York New York
| | | | - Mark L. Urken
- THANC (Thyroid, Head and Neck Cancer) Foundation New York New York
- Department of Otolaryngology—Head and Neck SurgeryIcahn School of Medicine at Mount Sinai New York New York
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5
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Simone M, Vesperini E, Viti C, Camaioni A, Lepanto L, Raso F. Intraparotid facial nerve schwannoma: two case reports and a review of the literature. ACTA OTORHINOLARYNGOLOGICA ITALICA 2019; 38:73-77. [PMID: 29756618 DOI: 10.14639/0392-100x-1170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 10/22/2016] [Indexed: 11/23/2022]
Abstract
SUMMARY Schwannomas are rare benign tumours that arise from Schwann cells. The most known and studied is the intracranial vestibular schwannoma, even if it is not the most frequent. More often schwannomas arise from peripheral sensitive nerves, and the vagous is most involved among the cranial nerves. Intraparotid schwannomas account for just 10% of all facial involvement, so they are an extremely rare localisation. At present, there are less than 100 cases described in the literature. We performed a retrospective analysis of parotidectomy in two Italian hospitals and present two cases of intraparotid schwannoma and a review of the literature. In the first case, we performed a parotidectomy with a stripping of tumour from the nerve. In the other case, a hypoglossal-facial neurorrhaphy was performed. Follow-up was 24 months in the first (House-Brackmann II degree in temporal-ocular and III in facial-cervical branches) and 30 months in the second case (House-Brackmann III degree in both temporal-ocular and facial-cervical branches). Preoperative diagnosis of facial nerve schwannoma is a challenge; however, it is extremely important since post-operative palsy is common and often higher grade. Unfortunately, schwannoma has similar radiologic finding as more common pleomorphic adenoma and often FNAC is not helpful. Due to its rarity and benign nature, there is debate in the literature on the need for surgical removal. Wait-and-see is a valid option, but may could give problems in secondary surgery. Stripping or near-total removal can be useful in cases of limited involvement of the nerve. Neurorrhaphy can provide good functional results when facial sacrifice is needed.
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Affiliation(s)
- M Simone
- Department of Otorhinolaryngology, Head and Neck Surgery, San Giovanni Addolorata Hospital, Roma, Italy
| | - E Vesperini
- Department of Otorhinolaryngology, Head and Neck Surgery, San Giovanni Addolorata Hospital, Roma, Italy
| | - C Viti
- Department of Otorhinolaryngology, Head and Neck Surgery, San Giovanni Addolorata Hospital, Roma, Italy
| | - A Camaioni
- Department of Otorhinolaryngology, Head and Neck Surgery, San Giovanni Addolorata Hospital, Roma, Italy
| | - L Lepanto
- Department of Otorhinolaryngology, Head and Neck Surgery, Garibaldi Hospital, Palermo, Italy
| | - F Raso
- Department of Otorhinolaryngology, Head and Neck Surgery, Garibaldi Hospital, Palermo, Italy
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6
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López F, Suárez C, Vander Poorten V, Mäkitie A, Nixon IJ, Strojan P, Hanna EY, Rodrigo JP, de Bree R, Quer M, Takes RP, Bradford CR, Shaha AR, Sanabria A, Rinaldo A, Ferlito A. Contemporary management of primary parapharyngeal space tumors. Head Neck 2018; 41:522-535. [PMID: 30549361 DOI: 10.1002/hed.25439] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 06/19/2018] [Accepted: 07/06/2018] [Indexed: 01/28/2023] Open
Abstract
The parapharyngeal space is a complex anatomical area. Primary parapharyngeal tumors are rare tumors and 80% of them are benign. A variety of tumor types can develop in this location; most common are salivary gland neoplasm and neurogenic tumors. The management of these tumors has improved greatly owing to the developments in imaging techniques, surgery, and radiotherapy. Most tumors can be removed with a low rate of complications and recurrence. The transcervical approach is the most frequently used. In some cases, minimally invasive approaches may be used alone or in combination with a limited transcervical route, allowing large tumors to be removed by reducing morbidity of expanded approaches. An adequate knowledge of the anatomy and a careful surgical plan is essential to tailor management according to the patient and the tumor. The purpose of the present review was to update current aspects of knowledge related to this more challenging area of tumor occurrence.
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Affiliation(s)
- Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Vincent Vander Poorten
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Antti Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Iain J Nixon
- NHS Lothian, University of Edinburgh, Edinburgh, United Kingdom
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Juan Pablo Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Miquel Quer
- Department of Otolaryngology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Clínica Vida/Instituto de Cancerología Las Américas, Medellín, Colombia
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group
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7
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Eroglu U, Yakar F, Zaimoglu M, Sayaci E, Ozgural O, Dogan İ, Ugur HC. Subcutaneous Schwannoma in the Head Region. Asian J Neurosurg 2018; 13:96-97. [PMID: 29492133 PMCID: PMC5820908 DOI: 10.4103/1793-5482.185064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Schwannoma is a benign neural tumor derived from Schwann cells surrounding the nerves. It occurs primarily in subcutaneous tissues and muscles with a tendency for distal extremities, head, and neck area. Treatment of schwannoma is surgical excision. Lipomas are the most common soft-tissue lesions. A case is presented to increase awareness on differential diagnosis of head and neck subcutaneous masses.
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Affiliation(s)
- Umit Eroglu
- Department of Neurosurgery, Ankara University Medical School, Ibni Sina Hospital, Ankara, Turkey
| | - Fatih Yakar
- Department of Neurosurgery, Ankara University Medical School, Ibni Sina Hospital, Ankara, Turkey
| | - Murat Zaimoglu
- Department of Neurosurgery, Ankara University Medical School, Ibni Sina Hospital, Ankara, Turkey
| | - Emre Sayaci
- Department of Neurosurgery, Ankara University Medical School, Ibni Sina Hospital, Ankara, Turkey
| | - Onur Ozgural
- Department of Neurosurgery, Ankara University Medical School, Ibni Sina Hospital, Ankara, Turkey
| | - İhsan Dogan
- Department of Neurosurgery, Ankara University Medical School, Ibni Sina Hospital, Ankara, Turkey
| | - Hasan Caglar Ugur
- Department of Neurosurgery, Ankara University Medical School, Ibni Sina Hospital, Ankara, Turkey
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8
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Extracranial Trigeminal Schwannomas: A Retrospective Analysis. J Maxillofac Oral Surg 2017; 16:164-169. [PMID: 28439155 DOI: 10.1007/s12663-016-0939-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 06/29/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To analyse the clinic-radiological features and treatment outcome of extracranial trigeminal schwannomas. METHOD Medical records and radiographs of patients treated, from January 2011 to December 2013, for neurogenic tumors were retrospectively reviewed. Extracranial schwannomas other than those of trigeminal nerve were also excluded. A number of parameters, including the patient's age, gender, site, clinical features, radiographic features, histologic variants and treatment provided as well as any associated complications were recorded and analysed. RESULT A total of 5 patients met the inclusion criteria. The patients were males, aged 16-56 years. All the schwannomas appear to originate from the terminal branches of trigeminal nerve. CONCLUSION Long standing asymptomatic swelling of cheek should include trigeminal schwannomas as the differential diagnosis. The diagnosis though confirmed by the histologic examination but can also be made on the basis of MRI finding. Neural function can be preserved by meticulous surgery.
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9
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Montano N, D'Alessandris QG, D'Ercole M, Lauretti L, Pallini R, Di Bonaventura R, La Rocca G, Bianchi F, Fernandez E. Tumors of the peripheral nervous system: analysis of prognostic factors in a series with long-term follow-up and review of the literature. J Neurosurg 2016; 125:363-71. [DOI: 10.3171/2015.6.jns15596] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECT
Only a few published studies of the surgical treatment of benign peripheral nerve sheath tumors (BPNSTs), malignant peripheral nerve sheath tumors (MPNSTs), and peripheral non–neural sheath tumors (PNNSTs) have analyzed the results and possible prognostic factors using multivariate analysis. The authors report on their surgical series of cases of BPNSTs, MPNSTs, and PNNSTs with long-term follow-up and analyze the role of selected factors with respect to the prognosis and risk of recurrence of these tumors using multivariate analysis. They also review the pertinent literature and discuss their results in its context.
METHODS
The authors retrospectively reviewed data from cases involving patients who underwent resection of a peripheral nerve tumor between January 1983 and December 2013 at their institution. Of a total of 200 patients, 150 patients (with 173 surgically treated tumors) had adequate follow-up data available for analysis. Pain was assessed using a visual analog scale (VAS), and motor and sensory function were assessed by means of the Louisiana State University grading system. They also analyzed the relationship between tumor recurrence and patient sex, patient age, diagnosis of neurofibromatosis (NF), tumor histopathology, tumor size, tumor location, and extent of resection (subtotal vs gross-total resection), using univariate and multivariate analyses.
RESULTS
There was a statistically significant improvement in the mean VAS pain score (preoperative 3.96 ± 2.41 vs postoperative 0.95 ± 1.6, p = 0.0001). Motor strength and sensory function were significantly improved after resection of tumors involving the brachial plexus (p = 0.0457 and p = 0.0043, respectively), tumors involving the upper limb (p = 0.0016 and p = 0.0016, respectively), BPNSTs (p = 0.0011 and p < 0.0001, respectively), and tumors with dimensions less than 5 cm (motor strength: p = 0.0187 and p = 0.0021 for ≤ 3 cm and 3–5 cm tumors, respectively; sensory function: p = 0.0003 and p = 0.0001 for ≤ 3 cm and 3–5 cm tumors, respectively). Sensory function showed a statistically significant improvement also in patients who had undergone resection of tumors involving the lower limb (p = 0.0118). Total resection was associated with statistically significant improvement of motor strength (p = 0.0251) and sensory function (p < 0.0001). In univariate analysis, a history of NF (p = 0.0034), a diagnosis of MPNST or PNNST (p < 0.0001), and subtotal resection (p = 0.0042) were associated with higher risk of tumor recurrence. In multivariate analysis (logistic regression analysis), a history of NF (OR 9.28%, 95% CI 1.62–52.94, p = 0.0121) and a diagnosis of MPNST (OR 0.03%, 95% CI 0.002–0.429, p = 0.0098) or PNNST (OR 0.081%, 95% CI 0.013–0.509, p = 0.0077) emerged as independent prognostic factors for tumor recurrence.
CONCLUSIONS
A total resection should be attempted in all cases of peripheral nervous system tumors (irrespective of the supposed diagnosis and tumor dimensions) because it is associated with better prognosis in term of functional outcome and overall survival. Moreover, a total resection predicts a lower risk of tumor recurrence. Patients with a history of NF and tumors with malignant histology remain a challenge both for neurosurgeons and oncologists due to higher recurrence rates and the lack of standardized adjuvant therapies.
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10
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Wang HK, Gong YL, Wang RX, Zheng XT, Huang SY, Zhang DS. A rare occurrence of intramasseteric schwannoma - case report and literature review. ACTA ACUST UNITED AC 2016; 117:170-2. [PMID: 27155941 DOI: 10.1016/j.revsto.2016.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/25/2016] [Indexed: 10/21/2022]
Abstract
A schwannoma is a benign, solitary, well-defined, painless, slowly-enlarging nerve sheath tumor, composed of Schwann cells. Intramasseteric localization is very unusual. We report the case of a 33-year-old male who developed an intramasseteric schwannoma. Tumor could be completely removed under general anesthesia. Histopathological examination made the diagnosis of intramasseteric schwannoma through the presence of Antoni A areas and Verocay bodies. The diagnosis of schwannoma should be taken into consideration in case of parotideomasseteric tumors.
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Affiliation(s)
- H-K Wang
- Weihai Municipal Hospital, Department of Oral and Maxillofacial Surgery, Weihai 264200, China; Shandong Provincial Hospital Affiliated to Shandong University, Department of Oral and Maxillofacial Surgery, Jinan 250021, China.
| | - Y-L Gong
- Weihai Women and Children Hospital, Department of Stomatology, Weihai 264200, China
| | - R-X Wang
- Weihai Municipal Hospital, Department of Oral and Maxillofacial Surgery, Weihai 264200, China
| | - X-T Zheng
- Weihai Municipal Hospital, Department of Oral and Maxillofacial Surgery, Weihai 264200, China
| | - S-Y Huang
- Shandong Provincial Hospital Affiliated to Shandong University, Department of Oral and Maxillofacial Surgery, Jinan 250021, China
| | - D-S Zhang
- Shandong Provincial Hospital Affiliated to Shandong University, Department of Oral and Maxillofacial Surgery, Jinan 250021, China
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11
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Wong BLK, Bathala S, Grant D. Laryngeal schwannoma: a systematic review. Eur Arch Otorhinolaryngol 2016; 274:25-34. [PMID: 27020268 DOI: 10.1007/s00405-016-4013-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 03/23/2016] [Indexed: 11/26/2022]
Abstract
A large proportion of schwannomas are found in the head and neck region. Schwannoma located within the larynx however is uncommon. The characteristic features, clinical presentations, treatment and the outcomes of patients with laryngeal schwannoma are therefore not clearly understood. The aim of this comprehensive review is to compile, analyze and present the details to develop a consensus and augment the available literature on laryngeal schwannoma. A comprehensive literature search on laryngeal schwannoma was performed on PUBMED/MEDLINE, EMBASE, CINAHL and Science Citation Index using MeSH words. A total of 55 patients were reviewed in this study. 40.7 % of the tumours arose from the aryepiglottic fold or arytenoids. Other areas where tumours were found included the false cord, true vocal cord, epiglottis, subglottis, piriform sinus and the post cricoid area. 64.9 % patients presented with dysphonia. Others typically present with multiple symptoms related to the mass effect and location of the tumour. All patients were managed surgically with different techniques and approaches. Majority of patients were alive with no residual disease. There were five recurrences and no mortality to date. Schwannoma within the larynx can present with a variety of symptoms. Surgical excision remained as the treatment of choice with good overall prognosis.
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Affiliation(s)
- Billy L K Wong
- Department of Otolaryngology, Head and Neck Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK.
| | - S Bathala
- Department of Otolaryngology, Head and Neck Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK
| | - D Grant
- Department of Otolaryngology, Head and Neck Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK
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12
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Recent advances in surgical management of parapharyngeal space tumors. Curr Opin Otolaryngol Head Neck Surg 2015; 23:83-90. [DOI: 10.1097/moo.0000000000000134] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Schwannoma of the submandibular gland: a case report. J Med Case Rep 2014; 8:231. [PMID: 24968763 PMCID: PMC4082163 DOI: 10.1186/1752-1947-8-231] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 05/05/2014] [Indexed: 12/04/2022] Open
Abstract
Introduction Schwannoma is a benign, solitary, and slowly progressive encapsulated tumor originating from the sheath of myelinated nerve fibers. Schwannoma of the salivary gland is a particularly rare form of an extracranial neurogenic tumor. Here, we present an unusual case of a schwannoma of the submandibular gland in a 19-year-old man. Total excision of the submandibular gland resulted in complete resolution of symptoms with no cranial nerve deficits. The details of the histopathologic and immunohistochemical features are presented. Case presentation A 19-year-old Caucasian man was admitted to our clinic with a painless mass on the right side of his neck that he had had for the past four months. A neck examination revealed a smooth-surfaced, mobile, firm, and painless mass, 6cm in its greatest diameter, on the right side of the submandibular region. Fine-needle aspiration cytology was suggestive of a submandibular gland schwannoma. After the initial evaluation, our patient was prepared for surgical evaluation and resection with a presumptive diagnosis of a neurogenic tumor of the submandibular gland. The final diagnosis of schwannoma was verified by microscopic and immunohistochemical studies. At one-year follow-up of the case, there was no evidence of recurrence. Conclusions Schwannoma of the salivary gland is a particularly rare form of an extracranial neurogenic tumor. Our findings indicate good prognosis in an unusual case of a submandibular gland schwannoma in a 19-year-old man treated by surgical excision with no recurrence within 12 months of follow-up.
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Nerve-sparing subcapsular resection of head and neck schwannomas: technique evaluation and literature review. The Journal of Laryngology & Otology 2013; 127:685-90. [DOI: 10.1017/s0022215113001102] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:The head and neck region harbours crucial structures and hence the surgical technique used to remove schwannomas from this region should cause minimal damage to these structures, with complete removal of pathology.Methods:This study entailed a retrospective analysis of 10 patients with head and neck schwannomas that were excised using a nerve-sparing subcapsular dissection technique. The primary aims were to assess the functional impact of the surgical technique on the structure of origin and to evaluate local control.Results:One patient with parapharyngeal schwannoma developed symptoms suggestive of ‘first bite syndrome’ in the late post-operative period. Another patient with facial nerve schwannoma had House–Brackmann grade II weakness in the immediate post-operative period, which subsequently resolved. None of the patients developed recurrence during a median follow-up period of two years.Conclusion:The nerve-sparing subcapsular dissection technique provided effective local control of tumour pathology, with relative preservation of neural function post-operatively.
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Bondi S, Limardo P, Toma S, Bussi M. Non-vestibular head and neck schwannomas: a 10-year experience. Eur Arch Otorhinolaryngol 2013; 270:2365-9. [PMID: 23644938 DOI: 10.1007/s00405-013-2520-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 04/19/2013] [Indexed: 01/16/2023]
Abstract
Schwannomas are rare and slow growing tumours, arising from Schwann cells which provide myelin; less than 1% of them degenerate into a malignant state. Although most studies are based on acoustic schwannomas, the majority of these tumours are non-vestibular and extracranial. Up to 45% of them can be localised in head and neck districts, where they represent a diagnostic challenge because they are in differential diagnosis with lipoma, brachial cyst, paraganglioma and adenopathy. Between February 2002 and September 2012 our experience considers 18 patients affected by schwannomas localised in the neck in 14 cases, in the oral cavity in 2 cases, in the upper lip in 1 case and finally in the nose in 1 case. A painless neck mass was the major symptom referred, as well as dysphonia and oral pain. Ultrasound scan with fine needle aspiration biopsy was done in half of the group and was diagnostic in 30%, whereas magnetic resonance imaging was diagnostic in 77%, confirming its primary role in diagnostic work-up. The surgical approach was mainly by cervical incision and the intraneural extracapsular enucleation was the technique used without nerve injury in 89% of cases. Follow-up period was 6-120 months and no evidence of relapse was registered.
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Affiliation(s)
- S Bondi
- Otorhinolaryngology Unit, IRCCS San Raffaele Vita-Salute University, Via Olgettina 60, 20132 Milan, Italy.
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Gibber MJ, Zevallos JP, Urken ML. Enucleation of vagal nerve schwannoma using intraoperative nerve monitoring. Laryngoscope 2012; 122:790-2. [PMID: 22302608 DOI: 10.1002/lary.22485] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 10/01/2011] [Accepted: 10/13/2011] [Indexed: 11/09/2022]
Abstract
Vagal nerve schwannomas are rare, benign, neural sheath tumors. The treatment of enlarging or symptomatic vagal nerve schwannomas is surgical resection. Transecting the vagus nerve results in significant morbidity, and attempts at nerve preservation should be made whenever possible. We introduce a nerve-sparing technique using meticulous microsurgical dissection and intraoperative nerve monitoring for vagal schwannomas. A 61-year old patient presented with an enlarging 2-cm right vagal nerve schwannoma. She underwent resection via a transcervical approach. The patient was intubated with an electromyographic (EMG) endotracheal tube that allowed for monitoring of the recurrent laryngeal nerve intraoperatively. A microsurgical subcapsular dissection was performed after branches of the vagus nerve were identified using a nerve probe and preserved. At the conclusion of the resection the nerve was intact and stimulated along its entire course. Postoperatively, the patient had normal vagal nerve function. We introduced the role of intraoperative nerve monitoring using an EMG endotracheal tube for successful enucleation of vagal schwannomas. In conjunction with meticulous microsurgical dissection, nerve monitoring allows for successful preservation of the vagus nerve and decreased postoperative morbidity.
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Affiliation(s)
- Marc J Gibber
- Department of Otolaryngology-Head and Neck Surgery, Beth Israel Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
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Abstract
OBJECTIVES/HYPOTHESIS To analyze clinical and epidemiological features of neck nerve schwannomas, with emphasis on the neurologic outcome after surgical excision sparing as much of nerve fibers as possible with enucleation technique. STUDY DESIGN Retrospective study. METHODS Review of medical records from 1987 to 2006 of patients with neck nerve schwannomas, treated in a single institution. RESULTS Twenty-two patients were identified. Gender distribution was equal and age ranged from 15 to 61 years (mean: 38.6 years). Seven vagal, four brachial plexus, four sympathetic trunk, three cervical plexus, and two lesions on other sites could be identified. Most common symptom was neck mass. Local or irradiated pain also occurred in five cases. Median growing rate of tumors was 3 mm per year. Nerve paralysis was noted twice (a vagal schwannoma and a hypoglossal paralysis compressed by a vagal schwannoma). Different techniques were employed, and seven out of nine patients kept their nerve function (78%) after enucleation. No recurrence was observed in follow-up. CONCLUSIONS Schwannomas should be treated surgically because of its growing potential, leading to local and neural compression symptoms. When possible, enucleation, which was employed in 10 patients of this series, is the recommended surgical option, allowing neural function preservation or restoration in most instances. This is especially important in the head and neck, where denervation may have a significant impact on the quality of life.
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Kang GCW, Soo KC, Lim DTH. Extracranial Non-vestibular Head and Neck Schwannomas: A Ten-year Experience. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2007. [DOI: 10.47102/annals-acadmedsg.v36n4p233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Introduction: We present a series of head and neck extracranial non-vestibular schwannomas treated during a ten-year period, assessing epidemiology, presenting signs and symptoms, location, nerve of origin, diagnostic modalities, treatment and clinical outcome.
Materials and Methods: Clinical records of all patients with head and neck schwannomas treated at our department from April 1995 to July 2005 were retrospectively reviewed.
Results: There was female predominance (67%). The mean age at diagnosis was 48 years. Sixteen (76%) presented with a unilateral neck mass. Eleven schwannomas (52%) were in the parapharyngeal space. The most common nerves of origin were the vagus and the cervical sympathetic chain. The tumour may masquerade as a cervical lymph node and other myriad conditions. Treatment for all but 2 cases was complete excision with nerve preservation. Two cases of facial schwannoma required sacrifice of the affected nerve portion with nerve reconstruction. All facial schwannoma patients suffered postoperative facial palsy with only partial resolution (mean final House-Brackman grade, 3.25/6). Among non-facial schwannoma patients, postoperative neural deficit occurred in 12 with partial to complete resolution in 7. The median follow-up period was 24 months. No schwannoma was malignant and none recurred.
Conclusion: Non-vestibular extracranial head and neck schwannomas most frequently present as an innocuous longstanding unilateral parapharyngeal neck mass. Preoperative diagnosis may be aided by fine-needle cytology and magnetic resonance imaging or computed tomographic imaging. The mainstay of treatment is complete intracapsular excision preserving the nerve of origin, but for extensive tumour or facial schwannomas, subtotal resection or nerve sacrifice with reconstruction and rehabilitation are considerations. Surgery on intraparotid facial schwannomas carries considerable morbidity and conservative management has a place in treatment. Early recognition of facial schwannomas is key to optimal treatment.
Key words: Asian, Extracranial non-vestibular, Head and neck schwannomas, Single institution
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Zhang H, Cai C, Wang S, Liu H, Ye Y, Chen X. Extracranial Head and Neck Schwannomas: A Clinical Analysis of 33 Patients. Laryngoscope 2007; 117:278-81. [PMID: 17277622 DOI: 10.1097/01.mlg.0000249929.60975.a7] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study the clinical features, diagnosis, and management of the extracranial head and neck schwannomas. STUDY DESIGN Retrospective study. METHODS The clinical data of 33 patients with schwannoma of the head and neck from 1996 to 2006 were studied retrospectively. RESULTS Extracranial head and neck schwannomas usually presented as solitary and well-demarcated lesions with insidious course. Although benign, the lesion can cause secondary symptoms, such as nasal obstruction, dysphasia, and hoarseness, relevant to location of the lesion. Fine needle aspiration cytology, computed tomography scans, and magnetic resonance imaging may provide limited implications in the diagnosis of schwannomas, whereas postoperative pathologic examination establishes the final diagnosis. CONCLUSIONS Complete surgical excisions with appropriate approaches have proven to be efficient and successful in the treatment of head and neck schwannomas.
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Affiliation(s)
- Hao Zhang
- Division of Otolaryngology, Ruijin Hospital, School of Medicine, Jiao Tong University, Shanghai, China.
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Tezer MS, Ozcan M, Han O, Unal A, Ozlugedik S. Schwannoma originating from the infraorbital nerve: A case report. Auris Nasus Larynx 2006; 33:343-5. [PMID: 16413981 DOI: 10.1016/j.anl.2005.11.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2005] [Revised: 09/28/2005] [Accepted: 11/11/2005] [Indexed: 11/23/2022]
Abstract
A 16-year-old female admitted to otolaryngology outpatient clinic with the complaints of pain and replacement of her left eyeball upwards. Radiological imaging demonstrated a solid mass inferior to the left globe. The anterior wall of the maxilla was thinned and the mass pushed the orbital floor inferiorly. Following subciliary incision, the bone over the mass was removed from the orbital rim and the mass was exposed. The mass originated from the infraorbital nerve. The mass was excised and the orbital rim, malar region and the orbital floor were reconstructed by a titanium mesh. The histopathological report was "schwannoma". Seven cases of schwannomas arising from the infraorbital nerve reported in English literature. In this paper we report a case of infraorbital schwannoma and review the literature.
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Affiliation(s)
- Mesut Sabri Tezer
- Department of Otorhinolaryngology, Numune Education and Research Hospital, Ankara, Turkey.
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Abstract
Schwannomas of the head and neck are uncommon tumors that arise from cranial, peripheral or autonomic nerves. In this study we review a series of 52 cases of schwannoma originating in the head and neck region over an 8-year period. All the tumors were benign, with the exception of one malignant schwannoma. The age range of the patients studied was 13-76 years and there was a predilection for males. Twenty-five schwannomas occurred in the scalp, face and external ear canal, 9 in the oral or nasal cavity and 18 in the neck. Seven cases of neck schwannoma originating from the major nerve system were found in the parapharyngeal space, all of which were located in the post-styloid compartment. Cervical plexus schwannomas originated either in the peripheral nerves or in an unidentified area of the nervous system; seven tumors were found in the posterior triangle of the neck and two in the anterior triangle. Two of the tumors originating in the brachial plexus were located in the posterior neck and one in the anterior neck. Tumors originating in the vagus nerve or sympathetic chain were all located in the anterior triangle of the neck.
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Affiliation(s)
- Y S Leu
- Department of Otolaryngology, Mackay Memorial Hospital, Taipei, Taiwan.
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Paiva Neto MA, Stamm AC, Braga FM. [Mandibular trigeminal schwannoma: case report]. ARQUIVOS DE NEURO-PSIQUIATRIA 2001; 59:959-63. [PMID: 11733846 DOI: 10.1590/s0004-282x2001000600023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We report one case of peripheral trigeminal schwannoma originated from the mandibular branch (V3) and located inside the infratemporal and pterygopalatine fossae with slight intracranial extension. The tumor was completely removed by a transmaxillary approach. The revision of the literature showed to be a very rare tumor in this location.
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Affiliation(s)
- M A Paiva Neto
- Disciplina de Neurocirurgia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil.
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