2024 Volume 117 Issue 4 Pages 351-355
Schwannomas are benign tumors that develop from Schwann cells and can arise in any part of the body. Cervical schwannomas are relatively rare, being particularly rare in children. We report the case of a child with sympathetic schwannoma arising in the parapharyngeal space. The patient was a 13-year-old girl, in whom computed tomographic examination revealed a tumor measuring 70 × 26 mm in size extending from the dorsal right carotid bifurcation to the parapharyngeal space, with heterogeneous internal enhancement. On magnetic resonance imaging, T1-weighted images showed iso- to hypointensity of the lesion, while T2-weighted images showed iso- to hyperintensity of the lesion, with heterogeneous enhancement within the lesion. At operation, the lower edge and dorsal aspect of the tumor was found to be contiguous with the sympathetic chain. After confirming nerve fibers coursing over the tumor, the epineurium was incised at a distant site from the nerve fibers, and intracapsular excision of the tumor was performed. Postoperatively, the patient developed mild Horner’s syndrome (ptosis and constricted pupil on the right side) and incomplete palsy of the mandibular branch of the facial nerve, both of which improved spontaneously within 2 months. There are no clear indications of surgery for cervical schwannoma. Moreover, various treatment options have been reported, including observation without surgery, biopsy without surgery, and surgey using various techniques. In the case of children, considering the patient’s life expectancy and potential of the tumor to grow, there is a high possibility that the tumor will continue to grow, and early surgery may reduce the risk of postoperative complications and avoid the need for highly invasive approaches. In children, it is necessary to consider performing surgery, as the surgical risk and risk of postoperative complications are low.
