Head and Neck Schwannomas: A Surgical Challenge—A Series of 5 Cases

Abstract

Background Schwannomas, also known as neurilemmomas, are benign peripheral nerve sheath tumors. They originate from any nerve covered with schwann cell sheath. Schwannomas constitute 25–45% of tumors of the head and neck. About 4% of head and neck schwannomas present as a sinonasal schwannoma. Brachial plexus schwannoma constitute only about 5% of schwannomas. Cervical vagal schwannomas constitute about 2–5% of neurogenic tumors. Methods We present a case series of 5 patients of schwannomas, one arising from the maxillary branch of trigeminal nerve in the maxillary sinus, second arising from the brachial plexus, third arising from the cervical vagus, and two arising from cervical spinal nerves. Result Complete extracapsular excision of the tumors was achieved by microneurosurgical technique with preservation of nerve of origin in all except one. Conclusion Head and neck schwannoma though rare should be considered as a differential diagnosis of a unilateral slow growing mass in the head and neck region, particularly in an adult. Schwannomas are always a diagnostic dilemma as they are asymptomatic for long time, and histopathology is the gold standard for diagnosis. As a rule, treatment is surgical and dictated by the location of the tumor and nerve of origin. Due to its rarity, complex anatomical location and morbidity risk postexcision, they can pose a formidable challenge to surgeons. This study aims to describe the presentation, workup, surgical technique, and outcome.

Transversalis Fascia and Preperitoneal Fascia: A Laparoscopic Study of Live Surgical Anatomy during TEPP Hernioplasty – Final Report and Literature Review

“…Details of the surgical technique were consistently the same as reported earlier by the author. [29,30,[36][37][38][39][40][41][42][43][44] Morphology of the transversalis fascia as well as preperitoneal fascia was observed carefully. Instant documentation and/or video recording were done.…”

“…Inferior to the Arcuate line, the deep inferior epigastric vessels (DIEV) were contained within the transversalis fascia (TF) with some reinforcement from the Rectusial fascia but superior to the Arcuate line, the DIEV were contained only within the variably thickened posterior epimysium of the rectus abdominis muscle, i.e., the Rectusial fascia as reported earlier by the author. [39,40] In other words, the DIEV vessels were not seen bare anterior to the transversalis fascia even in presence of thin flimsy TF (N=17). Moreover, in these patients with IC-PRS, entry into the preperitoneal space of either medial suprapubic region or lateral inguinal area was achieved by dividing the transversalis fascia at a convenient place as reported earlier by the author.…”

“…In these cases, the DIEV vessels were contained only within the Rectusial fascia throughout their course within the posterior rectus canal as was also documented earlier by the author. [39,40] Moreover, in patients with C-PRS, entry into the preperitoneal space of either medial suprapubic region or lateral inguinal area was achieved by dividing both the complete posterior rectus sheath and the transversalis fascia at a convenient place as was also documented elsewhere by the author. [44] In all cases studied, while working within the preperitoneal space between the transversalis fascia and the preperitoneal fascia, the DIEV vessels were found contained and covered by the transversalis fascia but always visible across it clearly or faintly depending upon the character of the transversalis fascia [ Figure 4 and 5].…”

Malignant peripheral nerve sheath tumor in the maxilla. Clinical сase

“…В полости рта встречается не более 1 % от общего чи сла ЗОПН головы и шеи, их преимущественной локализацией считается корень языка. Расположение в области альвеолярного отростка верхней челюсти, так же как и внутрикостное расположение образований этой морфологической группы, наблюдается крайне редко [1][2][3].…”

“…Основной метод лечения ЗОПН -хирургический, однако из-за сложного анатомического расположения и риска развития неврологического дефицита после операции проведение операции по удалению ЗОПН может представлять сложность для хирурга [3]. Разрабатываются методы дооперационного определения принадлежности опухолевых масс к нерву [6], что в конечном итоге улучшает отдаленные результаты вмешательства и минимизирует выраженность послеоперационной неврологической симптоматики.…”