Anatomy

Schwannomas or neurilemmomas are solitary, predominantly benign, well-encapsulated tumors that arise from the Schwann cells of the peripheral nerve sheath.74 While these tumors can arise from nerves throughout the body, as many as one-half occur within the head and neck,75 and demonstrate a slight female predominance, presenting most commonly in the fourth and fifth decades.19 Within the head and neck, schwannomas can arise from the eighth cranial nerve (acoustic neuroma), the vagus nerve, or the sympathetic chain, and less commonly from cranial nerves VII, IX, XI, XII, the cervical nerve roots, the brachial plexus, and the sinonasal tract (maxillary/ ophthalmic branches of trigeminal nerve or auto-nomic ganglia)19,74-80 As they grow, these tumors manifest a pushing pattern of expansion potentially permitting the separation and preservation of the integrity of the nerve from which they arise (Figure 16-15).74,76 This review will focus on schwannomas that arise from neural structures in the neck. While a discussion of facial schwannomas and acoustic neuromas is beyond the scope of this review, the reader is referred to textbooks of otology and neurotology for a more comprehensive treatment of these tumors.

Figure 16-15. A, Schwannoma of the brachial plexus. S, Schwannoma attached to its nerve of origin. C, Surgical resection specimen.

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