title: An algorithm for treating extracranial head and neck schwannomas.
abstract: Surgical resection of extracranial head and neck schwannomas (ECHNS) may be associated with major morbidity, but some ECHNSs can be safely treated expectantly. The aim of this study is to present a large case series and an algorithm for therapeutic decision-making in the management of ECHNS. The clinical records of patients diagnosed and treated for ECHNS between 1999 and 2012 at The Tel Aviv Sourasky Medical Center were reviewed retrospectively. All relevant demographic and medical data were extracted, among them presenting symptoms, surgical approaches, nerve of origin, complications and follow-up. A total of 53 patients with ECHNS were included in this clinical study. There were 29 males and 24 females whose mean age was 49.2 years, and all were treated surgically. The schwannomas originated from the brachial plexus, sympathetic chain, vagus nerve, trigeminal nerve, lip, hypoglossal nerve and larynx. Intracapsular enucleation was performed in 32 (60 %) patients, and the remaining 21 (40 %) patients underwent complete excision of the tumor with the involved nerve segment. Thirty-two patients (60 %) had postoperative neurological deficits. This study provides an algorithm to serve as a guideline in the decision-making process for this patient population. Although there is abundant evidence regarding the efficacy of radiotherapy for acoustic schwannoma, the value of radiotherapy as a treatment alternative for patients with ECNHS, especially those unsuitable for surgery, has not been established and further studies are warranted.
authors: Department of Otolaryngology, Head and Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weitzman Street, 64239, Tel Aviv, Israel.
authors: Daniel
authors: D
authors: Yafit
authors: Gilad
authors: G
authors: Horowitz
authors: Iosif
authors: I
authors: Vital
authors: Garrett
authors: G
authors: Locketz
authors: Dan M
authors: DM
authors: Fliss
mesh_terms: D000465:Algorithms; D000066491:Clinical Decision-Making / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006257:Head / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery; D009442:Neurilemmoma / Q000175:diagnosis / Q000601:surgery; D011184:Postoperative Period; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D014276:Trigeminal Nerve / Q000473:pathology; D014630:Vagus Nerve / Q000473:pathology