An unexpected complication of hypoglossal schwannoma surgery: Cerebrospinal fluid leakage—A case report and literature review

Abstract

BackgroundExtracranial hypoglossal schwannoma is a rare tumor primarily treated with surgical excision. This article aims to highlight the potential for unexpected complications intraoperatively, such as cerebrospinal fluid leakage from skullbase to neck.MethodsA previously healthy 23‐year‐old male presented with tongue numbness. Magnetic resonance imaging revealed a 17 × 20 mm nodular lesion adjacent to the cervical segment of the internal carotid artery. Surgical excision was scheduled due to suspicion of a neurogenic tumor.ResultsIntraoperatively, despite careful handling, cerebrospinal fluid leakage was observed. Manipulation of the mass caused detachment of proximal nerve fibers, potentially indicating avulsion of the hypoglossal nerve from the brainstem or nearby. Clear fluid leakage from the skull base was also noted.ConclusionThorough preoperative evaluation and patient education regarding potential complications are crucial. This article presents an unexpected complication encountered during surgical excision of extracranial hypoglossal schwannoma, emphasizing the need for awareness and preparedness in such cases.

Extracranial Hypoglossal Schwannoma: Case Report and Literature Review

“…Schwannomas are rare benign neoplasms, originating from myelin-producing Schwann's cells, with predilection for sensory nerves (1,(3)(4)(5). They represent less than 1% of the neoplasms seen in the head and neck region.…”

“…The primary objective is the complete tumor resection with meticulous dissection from the nerve fascicles. Studies have shown that intracapsular enucleation preserves nerve function without recurrence (5,23). En bloc resection of the nerve has been suggested to reduce the risk of recurrence and potential for sarcomatous transformation (24).…”

“…Our approach was to perform en bloc resection of the tumor and its origin tissue. In cases that require a total or partial excision of the nerve, a reconstruction with graft from the greater auricular nerve is feasible (5,8).…”

“…Schwannomas are solitary, benign, slow-growing, and wellencapsulated neurogenic neoplasms originating from the myelin-producing Schwann cells of the peripheral nerves (1)(2)(3)(4)(5)(6). They can involve the cranial nerves, such as V, VII, X, XI, and XII or sympathetic and peripheral nerves (7)(8)(9)(10)(11).…”

“…Extracranial schwannomas that manifest clinically in the submandibular region mostly originate from the hypoglossal nerve and comprise less than 5% of all head and neck schwannomas (1,2). De Martel first described them in 1933, and only a few cases have been reported in the international literature since then (1,5,14). As shown in Table I, a review of the literature revealed only a small number of publications on this topic.…”