What is a Schwannoma Around the Carotid Artery?

The head and neck schwannomas are tumors that originate from the myelin-producing Schwann cells located in the nerve sheath. Schwannomas may occur along the path of a nerve, cranial nerves or the autonomic nervous system. They usually occur in patients with an age range between 20 and 50 years and have a similar incidence in both sexes. They are initially asymptomatic, solitary, slow growing, and benign.

Neck schwannomas are located primarily in the parapharyngeal space (a cavity adjacent to the upper pharynx). Imaging techniques such as ultrasound, computer tomagraphy (CT) and magnetic resonance imaging (MRI) serve as elements to determine the location and extent of the tumor. In particular MRI is able to not only shows the tumor, but also from which nerve it develops. Other tests such as magnetic resonance angiography or angiography can be very useful to rule out other types of tumors.

Tumors arising from the parapharyngeal space (PPS) are rare. The most commonly involved nerve is the vagus. Fewer than 60 cervical sympathetic chain schwannomas have been reported. Schwannomas that develop around the carotid artery may cause a displacement of both the internal and external carotid arteries.

How are They Diagnosed?

Schwannomas are asymptomatic. Schawannomas can be detected while doing an X ray on the neck for other health issues (for example chronic neck pain). However, neck pain has nothing to do with schwannomas. As the schwannoma around the carotid artery grows it may become a palpable mass and the patient may feel a lump in the neck which will cause him (or her) to go to a doctor. Further CT or MRI will confirm the tumor location. Schwannomas in the neck also may elicit some hoarseness and coughing.

Are there any treatments?

Surgical removal of the tumor in recommended. Scwannomas are usually non-recurrent so removing them is efficient in 80 to 90% of the cases. However, the surgical procedure is delicate. Essentially, the nerve needs to be opened and the tumor removed. This is done under general anesthesia and using microscopical instrumentation (microsurgery techniques). The nerve function is maintained since only a portion of the nerve is touched and the rest remains intact.

Schwannomas around the carotid are extremely rare. Fewer than 60 cases have been reported in the literature. They are small masses that develop near the carotid blood vessel and are usually asymptomatic. They can go undetected for years. Sometimes a lump is felt by the patient and hoarness and coughing may appear. Scwannomas are usually benign tumors. Complete surgical removal is recommended.

Sources:

New York Medical CenterWeb site;

Colreavy MP, Lacy PD, Hughes J, Bouchier-Hayes D, Brennan P, O'Dwyer AJ, et al. Head and neck schwannomas - a 10-year review. J Laryngol Otol 2000;114:119-24.