Head and neck schwannomas – a 10 year review

TLDR

Head and neck schwannomas are uncommon peripheral nerve tumors, accounting for 25–45 % of extracranial schwannomas, often presenting insidiously and diagnosed late, with poor overall survival (~15 %) despite uncertain adjuvant therapy and emerging ras‑oncogene inhibitors offering future hope. Benign lesions are treated by conservative surgical excision, mindful of potential vagal or sympathetic chain injury, while malignant schwannomas require wide excision when feasible.

Abstract

Schwannomas of the head and neck are uncommon tumours that arise from any peripheral, cranial or autonomic nerve. Twenty-five to 45 per cent of extracranial schwannomas occur in the head and neck region and thus are usually in the domain of the otolaryngologist. They usually present insidiously and thus are often diagnosed incorrectly or after lengthy delays, however, better imaging and cytological techniques have lessened this to some degree more recently. For benign lesions conservative surgical excision is the treatment of choice bearing in mind possible vagal or sympathetic chain injury. Malignant schwannomas are best treated with wide excision where possible. The role of adjuvant therapy remains uncertain and irrespective of treatment modality prognosis is poor with an overall survival of 15 per cent. However, recent advances in ras oncogene inhibitors may hold hope for the future.