Benign Extracranial Nerve Sheath Tumors of the Skull Base: Postoperative Morbidity and Management

ABSTRACT

The purposes of this retrospective case series study were to examine the outcome of the operative treatment of extracranial nerve sheath tumors (NSTs) of the skull base and to learn the optimal management. The study was conducted at a university teaching hospital and a regional referral center. A total of 19 cases of benign extracranial NSTs of the skull base who presented to the otolaryngology department over a period of 10 years were studied regarding the clinical, radiological, and pathological features and the operative and postoperative management. In the majority, these tumors originated from cranial nerves; postoperative complications were frequent and depended on the nerve of origin. Postoperative nerve deficit was apparent in 10 cases, and a second operation was necessary in 8 cases. The greatest postoperative morbidity was associated with the parapharyngeal NSTs (i.e., dysphagia in 30%, dysphonia in 30%, and Horner's syndrome in 20% of cases). The conclusion from this study is that high postoperative morbidity resulting from surgery on skull base NSTs demands an integrated approach between the otolaryngologist, plastic surgeon, neurosurgeon, speech therapist, physiotherapist, dietician, and occupational therapist and a clear strategy of long-term follow-up.

Benign - neurofibroma - schwannoma - extracranial - skull base

REFERENCES

• 1 Varma D G, Moulopoulos A, Sara A S et al.. MR imaging of extracranial nerve sheath tumors.  J Comput Assist Tomogr. 1992;  16 448-453
• 2 Parker G D, Harnsberger H R. Clinical-radiologic issues in perineural tumour spread of malignant diseases of the extracranial head and neck.  Radiographics. 1991;  11 383-399
• 3 Leonetti J P, Wachter B, Marzo S J, Petruzzelli G. Extracranial lower cranial nerve sheath tumors.  Otolaryngol Head Neck Surg. 2001;  125 640-644
• 4 Katz A D, McAlpin C. Face and neck neurogenic neoplasms.  Am J Surg. 1993;  166 421-423
• 5 Kempf H G, Becker G, Weber B P, Ruck P, Lenarz T. Diagnostic and clinical outcome of neurogenic tumours in the head and neck area.  ORL J Otorhinolaryngol Relat Spec. 1995;  57 273-278
• 6 Malone J P, Lee W J, Levin R J. Clinical characteristics and treatment outcome for nonvestibular schwannomas of the head and neck.  Am J Otolaryngol. 2005;  26 108-112
• 7 Toriumi D M, Atiyah R A, Murad T, Sisson Sr G A. Extracranial neurogenic tumors of the head and neck.  Otolaryngol Clin North Am. 1986;  19 609-617