Mat Lazim Norhafiza
Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, 16150, Malaysia.
Int J Surg Case Rep. 2018;53:5-8. doi: 10.1016/j.ijscr.2018.10.025. Epub 2018 Oct 19.
Paraganglioma of head and neck is a rare tumor and vagal schwannoma is even rarer. The majority of patients with vagal schwannoma presents with a lateral neck mass. Its management is delicate as the need to confirm the diagnosis by histopathology via a biopsy is contraindicated. Here, is a case of a young female with vagal schwannoma complicated with hoarseness after the biopsy of the mass, which persists after extirpation of the tumor.
A 22-year old lady presented with a history of a right neck mass for a 5-months duration. Clinical examination revealed a mass at level II neck region which measures 3.0 cm × 2.0 cm and it was mobile, non-pulsatile and had smooth surfaced. CT scan and angiogram showed that the mass arose between the carotid artery and vagal nerve and it was a highly vascular lesion. A CT scan-guided biopsy performed but complicated with neck hematoma and patient developed hoarseness. On follow up, her hoarseness persists and her tissue biopsy came back as schwannoma. She was counseled regarding surgery versus radiation for her treatment and she agreeable for surgery. Hence, surgical excision was performed and intraoperatively the mass visualized arising from the vagal nerve. Postoperatively however, her voice did not improve.
Vagal schwannoma is a rare paraganglioma of head and neck and the best treatment is still controversial. Unnecessary investigation and procedure should be avoided in order to reduce morbidity as well as improves patient's quality of life.
头颈部副神经节瘤是一种罕见肿瘤，而迷走神经鞘瘤更为罕见。大多数迷走神经鞘瘤患者表现为颈部外侧肿块。由于禁忌通过活检进行组织病理学确诊，其治疗较为棘手。本文报告一例年轻女性，其迷走神经鞘瘤在肿块活检后并发声音嘶哑，肿瘤切除后声音嘶哑仍持续存在。
一名22岁女性，有右侧颈部肿块5个月病史。临床检查发现颈部II区有一肿块，大小为3.0 cm×2.0 cm，可活动，无搏动，表面光滑。CT扫描和血管造影显示肿块起源于颈动脉和迷走神经之间，是一个高血管病变。进行了CT扫描引导下活检，但并发颈部血肿，患者出现声音嘶哑。随访时，其声音嘶哑持续存在，组织活检结果为神经鞘瘤。就手术与放疗的治疗方案向她提供了咨询，她同意手术。因此，进行了手术切除，术中可见肿块起源于迷走神经。然而，术后她的声音并未改善。
迷走神经鞘瘤是一种罕见的头颈部副神经节瘤，最佳治疗方法仍存在争议。应避免不必要的检查和操作，以降低发病率并提高患者生活质量。
