Abstract
Cervical schwannomas are often found as painless asymmetric cervical masses, and symptoms of nerve palsy are rarely observed. We herein report a case of sympathetic schwannoma discovered in a patient with Horner syndrome. A 42-year-old man visited an ophthalmologist with eyelid ptosis as the main complaint and consulted our department because magnetic resonance imaging revealed a cervical mass. On a physical examination, eyelid ptosis and miosis were observed, and a tumor of elastic hardness was palpated at the upper right neck. On computed tomography, the mass was found to exist between the internal and external carotid arteries. Carotid body tumor was initially considered. As the tumor grew, it was pushed out between the carotid arteries.
Since MRI showed the bundle above and below the tumor and color Doppler ultrasonography revealed that the tumor was hypovascular, it was diagnosed as cervical sympathetic chain schwannoma.
Because the patient desired to undergo surgery, the procedure was performed under general anesthesia. Under the transcervical approach, the internal jugular vein, internal/external carotid artery and vagus nerve were identified. The tumor was located deeper than the internal carotid artery and the vagus nerve, and we confirmed that the nerve bundle was connected to the top and bottom of the tumor. Since paralysis had already developed, the nerve was cut above and below the tumor, and the tumor was removed and histopathologically diagnosed as a schwannoma.
