- 期刊
Neck Schwannoma Originating from the Vagus Nerve or Cervical Sympathetic Chain -- Two Case Reports
頸部許旺氏細胞瘤起源於迷走神經或頸部交感神經鏈－兩案例報告
摘要
Background: Neck schwannoma, arises from the vagus nerve and the cervical sympathetic chain, remains a challenge in differential diagnosis and surgical removal. Patients with neck schwannomas seldom complain of specific neurological symptoms. Diagnostic tools include ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI) and fine-needle aspiration cytology. Despite having these diagnostic tools, it can be difficult to detect the origin of the neck schwannoma before surgery. Aim and Objectives: This case report reviewed two patients with neck schwannomas and their different nerve of origin of cervical schwannomas as well as their clinical symptoms, image studies, intraoperative findings and postoperative complications. Materials and Methods: The first patient, a 42-year-old man who has had a painless, slow-growing tumor over the right neck for 6 years, showed a well-encapsulated heterogeneously-enhanced neck mass with cystic changes and calcifications in the neck contrast-enhanced CT. There was also an anterior deviation of the right common carotid artery and the right internal jugular vein. The second case was a 38-year-old woman with a painless, slow-growing, and immobile left neck mass for two years which the neck MRI identified as a well-encapsulated heterogeneous mass, above the common carotid artery bifurcation with an anterior deviation of the external carotid artery, internal carotid artery and internal jugular vein. On physical exams, both patients had no hoarseness or Horner's syndrome. Results: Intracapsular dissection with tumor enucleation was performed in both patients. The pathological reports demonstrated schwannomas in both cases. One arising from the fascicle of the vagus nerve revealed no postoperative vocal cord palsy, and the other from the cervical sympathetic chain developed postoperative Horner's syndrome and first bite syndrome, which resolved two months after the operation. Conclusion: Preoperative image studies of neck schwannomas show the spatial relationship between the tumor to carotid artery and internal jugular vein could differentiate the nerve of origin arising from the vagus nerve or the cervical sympathetic chain although some exceptions may exist. The nerve of origin of neck schwannoma and the surgical procedures are associated with the postoperative complications. Intracapsular enucleation of the cervical schwannoma with preservation of the nerve fascicles and minimizing the postoperative complications is the mainstay of therapy.
並列摘要
背景：頸部許旺氏細胞瘤起源於迷走神經或頸部交感神經鏈，在鑑別診斷和手術切除仍然是挑戰。病患甚少有神經學症狀，診斷工具包括了超音波、電腦斷層、核磁共振與細針穿刺細胞學檢查。目的及目標：這案例報告回顧二位頸部許旺氏細胞瘤患者的臨床症狀、影像學檢查、手術中發現、術後併發症與其不同的來源神經。材料及方法：第一位42歲男性患者，發現右頸無痛性，生長緩慢腫瘤已六個月，頸部電腦斷層顯示良好包膜，異質顯影性的頸部腫瘤，同時具有囊腫狀改變和鈣化。並且有右側總頸動脈與內頸靜脈向前移位。第二位38歲女性患者，發現左頸無痛性，生長緩慢的腫瘤已經二年，頸部核磁共振顯示良好包膜，異質顯影性的頸部腫瘤，位於總頸動脈分叉之上，合併外頸動脈、內頸動脈、內頸靜脈向前移位。理學檢查發現兩位病患都沒有聲音沙啞或霍納氏症候群（Horner's syndrome）。結果：兩位病患均執行囊內剝離併腫瘤摘除手術，病理報告證實都是許旺氏細胞瘤。第一位患者腫瘤起源於迷走神經，術後並無聲帶麻痺。第二位患者腫瘤起源於頸部交感神經鏈，並且合併術後霍納氏症候群（Horner's syndrome）和初次咀嚼症候群，這些症狀在術後兩個月緩解。結論：頸部許旺氏細胞瘤的術前影像學檢查，可顯示腫瘤相對於頸動脈與內頸靜脈的空間關係，能夠鑑別診斷起源神經是源於迷走神經或頸部交感神經鏈，但是仍有例外存在。頸部許旺氏細胞瘤的起源神經和手術方式與術後併發症有相關。頸部許旺氏細胞瘤，以囊內剝離併腫瘤摘除手術，可保留神經束和減低術後併發症，是主要的治療方式。