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Diagnostic Approach, Treatment, and Outcomes of Cervical Sympathetic Chain Schwannomas: A Global Narrative Review.
MedLine Citation:
PMID:  25214550     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: This review examined the diagnostic approach, surgical treatment, and outcomes of cervical sympathetic chain schwannomas (CSCS) to guide clinical decision making.
DATA SOURCES: Medline, EMBASE, and Cochrane databases.
REVIEW METHODS: A literature review from 1998 to 2013 identified 156 articles of which 51 representing 89 CSCS cases were evaluated in detail. Demographic, clinical, and outcomes data were extracted by 2 independent reviewers with high interrater reliability (κ = .79). Cases were mostly international (82%), predominantly from Asia (50%) and Europe (27%).
CONCLUSIONS: On average, patients were 42.6 years old (SD = 13.3) and had a neck mass ranging between 2 to 4 cm (52.7%) or >4 cm (43.2%). Nearly 70% of cases were asymptomatic at presentation. Presurgical diagnosis relied on CT (63.4%), MRI (59.8%), or both (19.5%), supplemented by cytology (33.7%), which was nearly always inconclusive (96.7%). US-treated cases were significantly more likely to receive presurgical MRI than internationally treated cases but less likely to have cytology (P < .05). Presurgical diagnosis was challenging, with only 11% confirmatory accuracy postsurgically. Irrespective of mass size, extracapsular resection (ie, complete resection with nerve sacrifice) was the most frequently (87.6%) performed surgical procedure. Common postsurgical adverse events included Horner's syndrome (91.1%), first bite syndrome (21.1%), or both (15.7%), with higher prevalence when mass size was >4 cm. Adverse events persisted in 82.3% of cases at an average 30.0 months (SD = 30.1) follow-up time.
IMPLICATIONS FOR PRACTICE: Given the typical CSCS patient is young and asymptomatic and the likelihood of persistent morbidity is high with standard surgical approaches, less invasive treatment options warrant consideration.
Authors:
Maryam Navaie; Leighla H Sharghi; Soojin Cho-Reyes; Michael A Keefe; Benjamin A Howie; Gavin Setzen
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-9-11
Journal Detail:
Title:  Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery     Volume:  -     ISSN:  1097-6817     ISO Abbreviation:  Otolaryngol Head Neck Surg     Publication Date:  2014 Sep 
Date Detail:
Created Date:  2014-9-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8508176     Medline TA:  Otolaryngol Head Neck Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.
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