Extracranial Head and Neck, Peripheral Nerve Tumors: A 10-Year Experience at NCI, Egypt

摘要

Background: Peripheral nerve tumors (PNT) originate from the neural crest and typically formed from Schwann cell sheath. Considering the number of nerves in this area, they form a very small percentage of neoplastic lesions of the head & neck. A solitary mass in the lateral neck frequently confronts the surgeon. An uncommon cause for such a nodule is a neoplasm arising from nerve tissue with PNTs being the commonest of them to face. Aims: To study the clinico-pathological characteristics, presentations, surgical approaches, postoperative complications & outcome of management. Materials & Methods: a single institution combined retrospective & prospective study. A retrospective analysis of all cases presented NCI-Cairo University with H&N extracranial PNST candidate for surgery from Jan 2009 until the end of Dec 2015 & prospective analysis of all cases with the same presentation presented to the NCI from Jan 2016 until the end of June 2019. 23 cases were included. Data were collected then analyzed. Results: Mean age was 34.7 years with female to male ratio 1.9:1. Mean size was 5.4 cm. Commonest presentation was asymptomatic neck lump located laterally in the neck (9 cases, 39%). CT scanning was done in 17 cases (74%). As regard pathology, we have only 4 malignant cases (17%). Most tumors (9 cases, 39%) originated from cranial nerves. 18 cases (78%) were resected through the neck. Complication occurred in 13 cases (56%), most of them during tumor dissection from its nerve origin or root. Vascular complications occurred in 6 cases (26%) due to bleeding controlled with ECA ligation (facial ischemia, hemiparesis & paresthesia). Cranial nerve injury (XI, XII) occurred in two cases (8.7%) & Speech defects in other two 2 cases (8.7%) due to maxillary resection. Postoperative?radiation was given to all 4 malignant cases (17%) of MPNST with Postoperative Chemotherapy to all cases experienced relapse after adjuvant RT. Post-operative palliative RT was given to (2 cases, 8.7%) with bone deposits. Conclusion: The vast majority of H&N extracranial PNTs are benign. Proper diagnosis is mandatory for ideal treatment. Complete R0 resection may not always be justified, therefore intracapsular or debulking procedures may have a role. The Malignant counterpart of PNTs (MPNST) is highly aggressive. They are treated with multimodality approach involving surgery with CTH & RT.