title: Diagnostic approach, treatment, and outcomes of cervical sympathetic chain schwannomas: a global narrative review.
abstract: OBJECTIVE
  This review examined the diagnostic approach, surgical treatment, and outcomes of cervical sympathetic chain schwannomas (CSCS) to guide clinical decision making.
  
  
  METHODS
  Medline, EMBASE, and Cochrane databases.
  
  
  METHODS
  A literature review from 1998 to 2013 identified 156 articles of which 51 representing 89 CSCS cases were evaluated in detail. Demographic, clinical, and outcomes data were extracted by 2 independent reviewers with high interrater reliability (κ = .79). Cases were mostly international (82%), predominantly from Asia (50%) and Europe (27%).
  
  
  CONCLUSIONS
  On average, patients were 42.6 years old (SD = 13.3) and had a neck mass ranging between 2 to 4 cm (52.7%) or >4 cm (43.2%). Nearly 70% of cases were asymptomatic at presentation. Presurgical diagnosis relied on CT (63.4%), MRI (59.8%), or both (19.5%), supplemented by cytology (33.7%), which was nearly always inconclusive (96.7%). US-treated cases were significantly more likely to receive presurgical MRI than internationally treated cases but less likely to have cytology (P < .05). Presurgical diagnosis was challenging, with only 11% confirmatory accuracy postsurgically. Irrespective of mass size, extracapsular resection (ie, complete resection with nerve sacrifice) was the most frequently (87.6%) performed surgical procedure. Common postsurgical adverse events included Horner's syndrome (91.1%), first bite syndrome (21.1%), or both (15.7%), with higher prevalence when mass size was >4 cm. Adverse events persisted in 82.3% of cases at an average 30.0 months (SD = 30.1) follow-up time.
  
  
  CONCLUSIONS
  Given the typical CSCS patient is young and asymptomatic and the likelihood of persistent morbidity is high with standard surgical approaches, less invasive treatment options warrant consideration.
authors.affiliation: Advance Health Solutions LLC, Boston, Massachusetts, USA mnavaie@advancehealthsolutions.com.
authors.forename: Maryam
authors.initials: M
authors.lastname: Navaie
authors.affiliation: Advance Health Solutions LLC, San Diego, California, USA.
authors.forename: Leighla H
authors.initials: LH
authors.lastname: Sharghi
authors.affiliation: Advance Health Solutions LLC, Chicago, Illinois, USA.
authors.forename: Soojin
authors.initials: S
authors.lastname: Cho-Reyes
authors.affiliation: Sharp Rees-Stealy Medical Group, San Diego, California, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Keefe
authors.affiliation: Advance Health Solutions LLC, Washington, DC, USA.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Howie
authors.affiliation: Albany ENT & Allergy Services PC, Albany, New York, USA.
authors.forename: Gavin
authors.initials: G
authors.lastname: Setzen
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D005728:Ganglia, Sympathetic / Q000473:pathology*; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D006732:Horner Syndrome / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D033262:Narration; D009442:Neurilemmoma / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D010524:Peripheral Nervous System Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Horner’s syndrome; adverse event; cervical sympathetic chain schwannoma; complications; first bite syndrome; head and neck schwannoma; narrative review; schwannoma