Sbai Achraf Amine, Bouchlarhem Saad, Benfadil Drissia, Lachkar Azeddine, Idrissi Fahd El Ayoubi El
Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.
Department of Otorhinolaryngology, Mohammed VI University Hospital Mohammed I University Oujda Morocco.
Radiol Case Rep. 2025 Jun 6;20(9):4221-4225. doi: 10.1016/j.radcr.2025.04.085. eCollection 2025 Sep.
Schwannomas are benign tumors that originate exclusively from Schwann cells, which form the myelin sheath of peripheral nerves. Schwannomas most commonly affect the vagus nerve, although other cranial nerves may also be involved. Involvement of the cervical sympathetic nervous system is exceedingly rare. We report the case of 34-year-old man with no significant medical history. Since the age of 8 years, he had presented with a right upper cervical mass neglected by the patient. The patient had presented for 4 months prior to admission with recurrent infections associated with inflammatory swelling of the mass, febrile episodes and, more recently, the appearance of significant dysphagia and odynophagia. Magnetic resonance imaging with gadolinium contrast confirmed the presence of a well-defined, mass along the cervical sympathetic chain suggestive of a schwannoma developed at the expense of the cervical sympathetic chain. Surgical exploration revealed a homogeneous mass measuring 4.5 × 5 cm, displacing the internal jugular vein anteriorly and the vagus nerve medially, close to the carotid vessels. In the immediate postoperative period, the patient developed isolated right-sided Claude Bernard-Horner syndrome and symptomatic management included a 7-day course of antibiotics and analgesics, as well as eye lubricant drops for 14 days. The clinical course was favorable. Early and appropriate management is essential to optimize functional prognosis and improve the patient's quality of life.
神经鞘瘤是一种仅起源于施万细胞的良性肿瘤，施万细胞形成周围神经的髓鞘。神经鞘瘤最常累及迷走神经，不过其他颅神经也可能受累。颈交感神经系统受累极为罕见。我们报告一例34岁男性患者，其无重大病史。自8岁起，他就出现了右侧上颈部肿块，一直被患者忽视。患者在入院前4个月出现反复感染，伴有肿块炎性肿胀、发热，最近还出现了明显的吞咽困难和吞咽痛。钆对比剂增强磁共振成像证实沿颈交感神经链存在一个边界清晰的肿块，提示神经鞘瘤以颈交感神经链为代价发展而来。手术探查发现一个大小为4.5×5厘米的均质肿块，将颈内静脉向前推移，迷走神经向内侧推移，靠近颈动脉。术后即刻，患者出现孤立性右侧霍纳综合征，对症治疗包括为期7天的抗生素和镇痛药疗程，以及为期14天的眼部润滑滴眼液。临床过程良好。早期且恰当的治疗对于优化功能预后和改善患者生活质量至关重要。
