A laterocervical approach to sympathetic chain schwannoma: step-by-step surgical technique

Schwannomas are histologically benign and slowly growing tumors arising from myelin-producing Schwann cells of the peripheral nervous system. About 25–45% of all schwannomas originate in the head and neck region, can occur anywhere along the course of the nerves and should be considered in differential diagnosis with other latero-cervical lesions [[1], [2], [3]]. A proper imaging study is mandatory to reach the correct diagnosis: schwannomas usually appear as heterogeneously enhancing encapsulated masses in Magnetic Resonance Imaging (MRI), hypointense in T1-weighted sequences and with variable T2 hyperintensity. Complete surgical removal represents the treatment of choice in the majority of cases [4]. The correct management and surgical approach is mainly based on dimension and location of the mass as long as its relationship with major vessels or structure [5]. We report an unusual case of schwannoma of the sympathetic chain in a 34–years-old female presenting a slow growing mass, mobile and pulsatile on the left latero-cervical region. The lesion was managed through lateral cervical approach. Complete excision was obtained, in order to avoid malignant transformation or mass effect.