Diagnosis and Management of Cervical Schwannomas: Is Surgery Always Necessary?

Schwannomas are benign, slow-growing, encapsulated tumors arising from Schwann cells of peripheral nerves. They are most frequently found in the head and neck region. While the vestibular nerve is the most common site for head and neck schwannomas, lesions of the neck are also common. Schwannomas are an important consideration in the differential diagnosis of neck masses. The origin of cervical schwannomas is most commonly the vagus nerve, but cases involving the cervical sympathetic chain and CNs IX, XI and XII have been reported. Patients generally present with a slow-growing, solitary, painless neck mass. Symptoms associated with dysfunction of the involved nerve or compression of adjacent structures may also be present. Voice changes, dysphagia, palatal asymmetry and Horner’s syndrome are examples. Malignant degeneration of these tumors is extremely rare. Clinical history, imaging and tissue sampling can help distinguish this entity from other neck masses, most specifically from paragangliomas. To date, the treatment of cervical schwannomas has been surgical excision. This study aims to demonstrate that diagnosis based mainly on clinical history and imaging can be accurate and that close observation is an appropriate management option for these lesions.