Diagnostic and Therapeutic Strategy for Vagal Schwannoma: Case Series and Literature Review. Medicina (Kaunas, Lithuania) Clinical management of vagal schwannoma is a real diagnostic and therapeutic challenge because the medical history and clinical examination are often non-specific and vagal nerve injury following surgical resection still represents an unsolved problem. The aim of this paper is to provide a case series along with a diagnostic and therapeutic algorithm for vagal schwannoma of the head and neck, combining our experience with clinical evidence available in the literature. We retrospectively analyzed a series of patients affected by vagal schwannoma who were treated between 2000 and 2020. In addition, a review of the literature on vagal schwannoma management was conducted. Based on the cases described and the literature review, we made a diagnostic and therapeutic algorithm for the management of vagal schwannoma. We were able to identify 10 patients affected by vagal schwannoma and treated between 2000 and 2020. All patients presented with a painless, mobile, slow-growing lateral neck mass with onset varying from a few months to years. The preoperative diagnostic workup included ultrasound (US) in nine cases, computed tomography (CT) with contrast in six patients and magnetic resonance imaging (MRI) of the neck in seven cases. All patients included in this study were surgically treated. Vagal schwannoma management represents a true challenge for clinicians and surgery is currently the most effective therapeutic strategy. A multidisciplinary approach through the collaboration of otolaryngologist with other specialists is desirable to develop a tailored treatment plan for the patient. 10.3390/medicina59061013

Extracranial Head and Neck Schwannomas: A Single Centre Retrospective Experience of 97 Cases. Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India Introduction:Schwannomas are rare benign neurogenic tumours. About 25-45% of extracranial schwannomas are found in the head and neck region. In the head and neck, they can arise from various cranial, peripheral and autonomic nerves. Due to this, they have varied clinical presentations. Material and Methods:This retrospective cohort includes 97 patients diagnosed with extra cranial head and neck schwannoma, and operated in the Otolaryngology and Head & Neck Surgery department, from 2013 to 2022. The parameters observed were the age and gender distribution, location, nerve of origin, size, pressure symptoms, cranial palsies, post-operative symptoms, recurrence and complications. The data were collected from the institute's electronic records. Results:The median age of the study population was 36 years; among them, 51 were men and 46 were women. The most common tumour location was parapharynx. The patients had varied head and neck symptoms, of which 23.7% had nerve paresis at presentation. Transcervical surgical approaches was most used. New onset cranial nerve paresis immediately post-surgery was noted in 22.7%. Recurrence was noted in 2% of cases. Conclusions:Extra cranial schwannomas are uncommon neoplasms and have varied presentations. Comprehensive evaluation with appropriate imaging should be done in all cases. Though benign, patients can present with nerve paresis. Recurrence is uncommon after complete resection. 10.1007/s12070-024-04839-w

Epidemiological, Clinical, and Histopathological Features of the Head and Neck Region Schwannomas-Our Experience in the Western Part of Romania with Surgical Insights. Diagnostics (Basel, Switzerland) INTRODUCTION:Schwannomas are benign solitary, slow-growing, encapsulated, asymptomatic tumors arising from Schwann's sheath of nervous fibers. OBJECTIVES:The current paper presents all the cases diagnosed with different types of schwannomas in the head and neck region between January 2009 and December 2023 in the Western part of Romania. In this period, ten cases of schwannoma were identified. MATERIALS AND METHODS:The pathological exams were performed at the Department of Pathology using morphological Hematoxylin-Eosin staining. In addition, immunohistochemical reactions were used in order to confirm the diagnosis. RESULTS:Demographic and clinical data, imaging features, surgical approach, and morphological and immunohistochemical aspects are presented. The results also display an impressive clinical picture of a gigantic ancient schwannoma. CONCLUSIONS:This retrospective study describes our experience with head and neck schwannomas, the diagnostic methods available, the surgical decisions, and the histopathological aspects while analyzing the data and reviewing the published specialized literature in the English language. 10.3390/diagnostics14202334

Diagnostic Utility of Restriction Spectrum Imaging in Head and Neck Tumors: A Pilot Study. Journal of computer assisted tomography OBJECTIVE:Imaging is crucial in the assessment of head and neck cancers for site, extension, and enlarged lymph nodes. Restriction spectrum imaging (RSI) is a new diffusion-weighted magnetic resonance imaging (MRI) technique that enhances the ability to differentiate aggressive cancer from low-grade or benign tumors and helps guide treatment and biopsy. Its contribution to imaging of brain and prostate tumors has been previously published. However, there are no prior studies using RSI sequence in head and neck tumors. The purpose of this study was to evaluate the feasibility of performing RSI in head and neck cancer. METHODS:An additional RSI sequence was added in the routine MRI neck protocol for 13 patients diagnosed with head and neck cancer between November 2018 and April 2019. Restriction spectrum imaging sequence was performed with b values of 0, 500, 1500, and 3000 s/mm 2 and 29 directions on 1.5T magnetic resonance scanners.Diffusion-weighted imaging (DWI) images and RSI images were compared according to their ability to detect the primary malignancy and possible metastatic lymph nodes. RESULTS:In 71% of the patients, RSI outperformed DWI in detecting the primary malignancy and possible metastatic lymph nodes, whereas in the remaining cases, the 2 were comparable. In 66% of the patients, RSI detected malignant lymph nodes that DWI/apparent diffusion coefficient failed to detect. CONCLUSIONS:This is the first study of RSI in head and neck imaging and showed its superiority over the conventional DWI sequence. Because of its ability to differentiate benign and malignant lymph nodes in some cases, the addition of RSI to routine head and neck MRI should be considered. 10.1097/RCT.0000000000001513