Unusual cases of cervical nerves schwannomas: phrenic and vagus nerve involvement

Anatomical study of phrenic nerve using ultrasound

“…Knowledge of the nerve's exact location, which may demonstrate individual variation, may have useful clinical applications, including optimisation of surgical approaches [9], facilitation of the accurate injection of anaesthetics when a regional block is considered and accurate study of phrenic nerve tumours [10][11][12][13]. Phrenic nerve block can indeed be used for the 3 Fig.…”

Schwannoma senil do nervo vago, ressecção com monitorização contínua do nervo laríngeo inferior

“…Schwannomas are infrequent and the SS variant has been described previously only once. 3 Surgery has a high rate of vocal fold injury and paralysis, particularly in tumors located close to the jugular foramen. 2 Fujino 6 (2000) described the intracapsular enucleation technique for vagus nerve tumors, which has become the standard surgical method -together with neurostimulation -for the treatment of these tumors.…”

“…3 These tumors appear mostly between the third and fifth decades of life; there is no sex predominance. 4 The clinical picture usually consists of a relatively pain-free bulge in the neck; the differential diagnosis should be made with other parapharyngeal tumors or neoplasms in the jugular foramen.…”

“…4 The clinical picture usually consists of a relatively pain-free bulge in the neck; the differential diagnosis should be made with other parapharyngeal tumors or neoplasms in the jugular foramen. 3 The senile schwannoma (SS) is a rare variant that was first described by Ackrman and Taylor in 1951; 2 its features are: wide areas of hyalinized matrix, hypercellularity with nuclear polymorphism and cell hyperchromatism. A microscopic description of SS in serial and histological sections reveals two cell types: the Antoni type A or fasciculated type (elongated cells, arranged in intertwining bundles in various directions or in a spiral layout), and the Antoni type B or reticular type (polymorphic cells that define small vacuoles, giving the tumor a honeycomb aspect).…”

“…5 Surgery is the treatment of choice; there is a high rate of vagus nerve injury during this procedure. 3 There are descriptions of resections of vagus nerve schwannomas associated with neurostimulation 3,6 and observation of esophageal6 contractions or endoscopic visualization of the larynx. 3 The current article is the first case report of resection of a vagus nerve schwannoma under continuous electrophysiological monitoring of the recurrent laryngeal nerve.…”