Management of Nerve Sheath Tumors Arising in the Sympathetic Chain

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Abstract and Introduction

Abstract

Background: Extradural schwannomas arising from the sympathetic chain are uncommon benign nerve sheath tumors. We present our experience with three patients having such tumors located in the cervical, thoracic and lumbar regions and we describe clinical presentation, surgical treatment, and outcomes.
Methods: Between 2002 and 2006, the medical records of three patients with pathologically proven sympathetic schwannomas at the Moffitt Cancer Center were reviewed retrospectively.
Results: The three patients were female, with a mean age of 44 years. Presentation and symptomatology varied between patients, and radiographic findings were not diagnostic. Complete excision of tumors was performed in all three patients without added morbidity or mortality. Surgical observation, histopathology, and immunohistochemistry confirmed the tumors to be schwannomas arising from the sympathetic chain. The schwannomas had a mean diameter of 3.2 cm and were all benign. At a mean follow-up of 21 months following resection, all patients remained free of disease recurrence.
Conclusions: Sympathetic schwannomas are rare tumors that are difficult to diagnose preoperatively. Diagnosis relies on clinical suspicion, and confirmation is often obtained by means of surgical pathology. Long-term surveillance is not recommended and surgical excision should be considered for this tumor, even though the tumor is considered benign and recurrence is rare.

Introduction

Extradural schwannomas arising from the sympathetic chain are uncommon benign nerve sheath tumors originating from Schwann cells. Diagnosis of the neural origin of the tumor and the ability to differentiate among the various histologic processes that occur in the paravertebral spine are important in preoperative planning.^[1] Similar to most neurogenic tumors, schwannomas present as asymptomatic masses. Treatment is either surgical resection or close observation.^[2,3,4]

We present our surgical experience with three such tumors located in the cervical, thoracic, and lumbar region. The clinical presentation, surgical treatment,and outcomes of patients with this pathology are described.

Cite this: Management of Nerve Sheath Tumors Arising in the Sympathetic Chain - Medscape - Sep 01, 2008.

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