Comprehensive analysis of radiological and surgical predictors in cervical sympathetic schwannomas: a novel staging approach and its implications
Background Vagal schwannomas are well-documented, but cervical sympathetic chain schwannomas (CSCS) are rare, with most knowledge from case reports. This study aims to identify radiological predictors of misdiagnosis and factors guiding surgical approaches based on tumor size and extent. Methods An...
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| Veröffentlicht in: | European archives of oto-rhino-laryngology 2025-02, Vol.282 (2), p.1005-1015 |
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| creator | Das K, Nidhin Muraleedharan, Manjul Keshri, Amit Arora, Kanika Singh, Neha Mathialagan, Arulalan Bhuskute, Govind Hameed, Nazrin Chidambaram, Kalyan Aqib, Mohd Sinha, Mohit Jaiswal, Awadesh Kumar Manogaran, Ravi Sankar |
| description | Background
Vagal schwannomas are well-documented, but cervical sympathetic chain schwannomas (CSCS) are rare, with most knowledge from case reports. This study aims to identify radiological predictors of misdiagnosis and factors guiding surgical approaches based on tumor size and extent.
Methods
An ambispective analysis was conducted on 21 cases of CSCS, examining preoperative data, intraoperative findings and the questionnaire to identify the potential predictors. Tumors were classified into three types based on their relationship with the carotid sheath, and this classification was correlated with vessel ligation and postoperative neural outcomes.
Results
An excellent agreement was found between radiologist on new classification system(Kappa:0.89). Tumor classification revealed a diverse distribution, with 6 cases identified as Type 1, 6 as Type 2, 5 as Type 3, and 4 as Type 3S. The necessity of external carotid artery (ECA) ligation correlated with the tumor type. Type 3 tumors required ECA ligation in 50% of cases, while Type 1 and Type 2 tumors predominantly involved vascular preservation. Postoperative complications included vagal palsy in 28.5% of cases and first bite syndrome in 71.4%.
Conclusion
Accurate preoperative planning and a novel staging system can enhance surgical outcomes and reduce postoperative complications as validated by our study. |
| doi_str_mv | 10.1007/s00405-024-08968-4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3105492129</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3105492129</sourcerecordid><originalsourceid>FETCH-LOGICAL-c228t-9db69b028e717c9954d2332f34856c1de5f9f6f53fa0e38eb90ce21666b1f7753</originalsourceid><addsrcrecordid>eNp9kctu1DAUhi0EotPCC7BAXrJJ8S1xzA6NykWqxAbWluOczLhK7OCTDJrH4I1xJ4UlK8s-___JOh8hbzi75Yzp98iYYnXFhKpYa5q2Us_IjiupKqVF85zsmJG6UkrrK3KN-MAYq5WRL8mVNELrVugd-b1P05zhCBHDCaiLbjxjQJoGml0f0pgOwbuxDHqKa94updAHv6SMNETqIZ8uz3ieZrccYQmeoj_-cjGmyeEH6mhMJyiBxR1CPFA3zzk5f7xQw1Io0zwWxBJSxFfkxeBGhNdP5w358enu-_5Ldf_t89f9x_vKC9Eulem7xnRMtKC59sbUqhdSikGqtm4876EezNAMtRwcA9lCZ5gHwZum6figdS1vyLuNW_7ycwVc7BTQwzi6CGlFK_njtgQXpkTFFvU5IWYY7JzD5PLZcmYfVdhNhS0q7EWFVaX09om_dhP0_yp_d18CcgtgGcUDZPuQ1lwE4P-wfwCHRJgG</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3105492129</pqid></control><display><type>article</type><title>Comprehensive analysis of radiological and surgical predictors in cervical sympathetic schwannomas: a novel staging approach and its implications</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Das K, Nidhin ; Muraleedharan, Manjul ; Keshri, Amit ; Arora, Kanika ; Singh, Neha ; Mathialagan, Arulalan ; Bhuskute, Govind ; Hameed, Nazrin ; Chidambaram, Kalyan ; Aqib, Mohd ; Sinha, Mohit ; Jaiswal, Awadesh Kumar ; Manogaran, Ravi Sankar</creator><creatorcontrib>Das K, Nidhin ; Muraleedharan, Manjul ; Keshri, Amit ; Arora, Kanika ; Singh, Neha ; Mathialagan, Arulalan ; Bhuskute, Govind ; Hameed, Nazrin ; Chidambaram, Kalyan ; Aqib, Mohd ; Sinha, Mohit ; Jaiswal, Awadesh Kumar ; Manogaran, Ravi Sankar</creatorcontrib><description>Background
Vagal schwannomas are well-documented, but cervical sympathetic chain schwannomas (CSCS) are rare, with most knowledge from case reports. This study aims to identify radiological predictors of misdiagnosis and factors guiding surgical approaches based on tumor size and extent.
Methods
An ambispective analysis was conducted on 21 cases of CSCS, examining preoperative data, intraoperative findings and the questionnaire to identify the potential predictors. Tumors were classified into three types based on their relationship with the carotid sheath, and this classification was correlated with vessel ligation and postoperative neural outcomes.
Results
An excellent agreement was found between radiologist on new classification system(Kappa:0.89). Tumor classification revealed a diverse distribution, with 6 cases identified as Type 1, 6 as Type 2, 5 as Type 3, and 4 as Type 3S. The necessity of external carotid artery (ECA) ligation correlated with the tumor type. Type 3 tumors required ECA ligation in 50% of cases, while Type 1 and Type 2 tumors predominantly involved vascular preservation. Postoperative complications included vagal palsy in 28.5% of cases and first bite syndrome in 71.4%.
Conclusion
Accurate preoperative planning and a novel staging system can enhance surgical outcomes and reduce postoperative complications as validated by our study.</description><identifier>ISSN: 0937-4477</identifier><identifier>ISSN: 1434-4726</identifier><identifier>EISSN: 1434-4726</identifier><identifier>DOI: 10.1007/s00405-024-08968-4</identifier><identifier>PMID: 39277827</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adult ; Aged ; Cranial Nerve Neoplasms - diagnostic imaging ; Cranial Nerve Neoplasms - pathology ; Cranial Nerve Neoplasms - surgery ; Female ; Head and Neck ; Head and Neck Neoplasms - diagnostic imaging ; Head and Neck Neoplasms - pathology ; Head and Neck Neoplasms - surgery ; Head and Neck Surgery ; Humans ; Ligation ; Magnetic Resonance Imaging - methods ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Neoplasm Staging ; Neurilemmoma - diagnostic imaging ; Neurilemmoma - pathology ; Neurilemmoma - surgery ; Neurosurgery ; Otorhinolaryngology ; Postoperative Complications ; Retrospective Studies ; Tomography, X-Ray Computed - methods ; Young Adult</subject><ispartof>European archives of oto-rhino-laryngology, 2025-02, Vol.282 (2), p.1005-1015</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024 Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c228t-9db69b028e717c9954d2332f34856c1de5f9f6f53fa0e38eb90ce21666b1f7753</cites><orcidid>0000-0001-5871-8187</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00405-024-08968-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00405-024-08968-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39277827$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Das K, Nidhin</creatorcontrib><creatorcontrib>Muraleedharan, Manjul</creatorcontrib><creatorcontrib>Keshri, Amit</creatorcontrib><creatorcontrib>Arora, Kanika</creatorcontrib><creatorcontrib>Singh, Neha</creatorcontrib><creatorcontrib>Mathialagan, Arulalan</creatorcontrib><creatorcontrib>Bhuskute, Govind</creatorcontrib><creatorcontrib>Hameed, Nazrin</creatorcontrib><creatorcontrib>Chidambaram, Kalyan</creatorcontrib><creatorcontrib>Aqib, Mohd</creatorcontrib><creatorcontrib>Sinha, Mohit</creatorcontrib><creatorcontrib>Jaiswal, Awadesh Kumar</creatorcontrib><creatorcontrib>Manogaran, Ravi Sankar</creatorcontrib><title>Comprehensive analysis of radiological and surgical predictors in cervical sympathetic schwannomas: a novel staging approach and its implications</title><title>European archives of oto-rhino-laryngology</title><addtitle>Eur Arch Otorhinolaryngol</addtitle><addtitle>Eur Arch Otorhinolaryngol</addtitle><description>Background
Vagal schwannomas are well-documented, but cervical sympathetic chain schwannomas (CSCS) are rare, with most knowledge from case reports. This study aims to identify radiological predictors of misdiagnosis and factors guiding surgical approaches based on tumor size and extent.
Methods
An ambispective analysis was conducted on 21 cases of CSCS, examining preoperative data, intraoperative findings and the questionnaire to identify the potential predictors. Tumors were classified into three types based on their relationship with the carotid sheath, and this classification was correlated with vessel ligation and postoperative neural outcomes.
Results
An excellent agreement was found between radiologist on new classification system(Kappa:0.89). Tumor classification revealed a diverse distribution, with 6 cases identified as Type 1, 6 as Type 2, 5 as Type 3, and 4 as Type 3S. The necessity of external carotid artery (ECA) ligation correlated with the tumor type. Type 3 tumors required ECA ligation in 50% of cases, while Type 1 and Type 2 tumors predominantly involved vascular preservation. Postoperative complications included vagal palsy in 28.5% of cases and first bite syndrome in 71.4%.
Conclusion
Accurate preoperative planning and a novel staging system can enhance surgical outcomes and reduce postoperative complications as validated by our study.</description><subject>Adult</subject><subject>Aged</subject><subject>Cranial Nerve Neoplasms - diagnostic imaging</subject><subject>Cranial Nerve Neoplasms - pathology</subject><subject>Cranial Nerve Neoplasms - surgery</subject><subject>Female</subject><subject>Head and Neck</subject><subject>Head and Neck Neoplasms - diagnostic imaging</subject><subject>Head and Neck Neoplasms - pathology</subject><subject>Head and Neck Neoplasms - surgery</subject><subject>Head and Neck Surgery</subject><subject>Humans</subject><subject>Ligation</subject><subject>Magnetic Resonance Imaging - methods</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neoplasm Staging</subject><subject>Neurilemmoma - diagnostic imaging</subject><subject>Neurilemmoma - pathology</subject><subject>Neurilemmoma - surgery</subject><subject>Neurosurgery</subject><subject>Otorhinolaryngology</subject><subject>Postoperative Complications</subject><subject>Retrospective Studies</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>Young Adult</subject><issn>0937-4477</issn><issn>1434-4726</issn><issn>1434-4726</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2025</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kctu1DAUhi0EotPCC7BAXrJJ8S1xzA6NykWqxAbWluOczLhK7OCTDJrH4I1xJ4UlK8s-___JOh8hbzi75Yzp98iYYnXFhKpYa5q2Us_IjiupKqVF85zsmJG6UkrrK3KN-MAYq5WRL8mVNELrVugd-b1P05zhCBHDCaiLbjxjQJoGml0f0pgOwbuxDHqKa94updAHv6SMNETqIZ8uz3ieZrccYQmeoj_-cjGmyeEH6mhMJyiBxR1CPFA3zzk5f7xQw1Io0zwWxBJSxFfkxeBGhNdP5w358enu-_5Ldf_t89f9x_vKC9Eulem7xnRMtKC59sbUqhdSikGqtm4876EezNAMtRwcA9lCZ5gHwZum6figdS1vyLuNW_7ycwVc7BTQwzi6CGlFK_njtgQXpkTFFvU5IWYY7JzD5PLZcmYfVdhNhS0q7EWFVaX09om_dhP0_yp_d18CcgtgGcUDZPuQ1lwE4P-wfwCHRJgG</recordid><startdate>202502</startdate><enddate>202502</enddate><creator>Das K, Nidhin</creator><creator>Muraleedharan, Manjul</creator><creator>Keshri, Amit</creator><creator>Arora, Kanika</creator><creator>Singh, Neha</creator><creator>Mathialagan, Arulalan</creator><creator>Bhuskute, Govind</creator><creator>Hameed, Nazrin</creator><creator>Chidambaram, Kalyan</creator><creator>Aqib, Mohd</creator><creator>Sinha, Mohit</creator><creator>Jaiswal, Awadesh Kumar</creator><creator>Manogaran, Ravi Sankar</creator><general>Springer Berlin Heidelberg</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5871-8187</orcidid></search><sort><creationdate>202502</creationdate><title>Comprehensive analysis of radiological and surgical predictors in cervical sympathetic schwannomas: a novel staging approach and its implications</title><author>Das K, Nidhin ; Muraleedharan, Manjul ; Keshri, Amit ; Arora, Kanika ; Singh, Neha ; Mathialagan, Arulalan ; Bhuskute, Govind ; Hameed, Nazrin ; Chidambaram, Kalyan ; Aqib, Mohd ; Sinha, Mohit ; Jaiswal, Awadesh Kumar ; Manogaran, Ravi Sankar</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c228t-9db69b028e717c9954d2332f34856c1de5f9f6f53fa0e38eb90ce21666b1f7753</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2025</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Cranial Nerve Neoplasms - diagnostic imaging</topic><topic>Cranial Nerve Neoplasms - pathology</topic><topic>Cranial Nerve Neoplasms - surgery</topic><topic>Female</topic><topic>Head and Neck</topic><topic>Head and Neck Neoplasms - diagnostic imaging</topic><topic>Head and Neck Neoplasms - pathology</topic><topic>Head and Neck Neoplasms - surgery</topic><topic>Head and Neck Surgery</topic><topic>Humans</topic><topic>Ligation</topic><topic>Magnetic Resonance Imaging - methods</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neoplasm Staging</topic><topic>Neurilemmoma - diagnostic imaging</topic><topic>Neurilemmoma - pathology</topic><topic>Neurilemmoma - surgery</topic><topic>Neurosurgery</topic><topic>Otorhinolaryngology</topic><topic>Postoperative Complications</topic><topic>Retrospective Studies</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Das K, Nidhin</creatorcontrib><creatorcontrib>Muraleedharan, Manjul</creatorcontrib><creatorcontrib>Keshri, Amit</creatorcontrib><creatorcontrib>Arora, Kanika</creatorcontrib><creatorcontrib>Singh, Neha</creatorcontrib><creatorcontrib>Mathialagan, Arulalan</creatorcontrib><creatorcontrib>Bhuskute, Govind</creatorcontrib><creatorcontrib>Hameed, Nazrin</creatorcontrib><creatorcontrib>Chidambaram, Kalyan</creatorcontrib><creatorcontrib>Aqib, Mohd</creatorcontrib><creatorcontrib>Sinha, Mohit</creatorcontrib><creatorcontrib>Jaiswal, Awadesh Kumar</creatorcontrib><creatorcontrib>Manogaran, Ravi Sankar</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European archives of oto-rhino-laryngology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Das K, Nidhin</au><au>Muraleedharan, Manjul</au><au>Keshri, Amit</au><au>Arora, Kanika</au><au>Singh, Neha</au><au>Mathialagan, Arulalan</au><au>Bhuskute, Govind</au><au>Hameed, Nazrin</au><au>Chidambaram, Kalyan</au><au>Aqib, Mohd</au><au>Sinha, Mohit</au><au>Jaiswal, Awadesh Kumar</au><au>Manogaran, Ravi Sankar</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comprehensive analysis of radiological and surgical predictors in cervical sympathetic schwannomas: a novel staging approach and its implications</atitle><jtitle>European archives of oto-rhino-laryngology</jtitle><stitle>Eur Arch Otorhinolaryngol</stitle><addtitle>Eur Arch Otorhinolaryngol</addtitle><date>2025-02</date><risdate>2025</risdate><volume>282</volume><issue>2</issue><spage>1005</spage><epage>1015</epage><pages>1005-1015</pages><issn>0937-4477</issn><issn>1434-4726</issn><eissn>1434-4726</eissn><abstract>Background
Vagal schwannomas are well-documented, but cervical sympathetic chain schwannomas (CSCS) are rare, with most knowledge from case reports. This study aims to identify radiological predictors of misdiagnosis and factors guiding surgical approaches based on tumor size and extent.
Methods
An ambispective analysis was conducted on 21 cases of CSCS, examining preoperative data, intraoperative findings and the questionnaire to identify the potential predictors. Tumors were classified into three types based on their relationship with the carotid sheath, and this classification was correlated with vessel ligation and postoperative neural outcomes.
Results
An excellent agreement was found between radiologist on new classification system(Kappa:0.89). Tumor classification revealed a diverse distribution, with 6 cases identified as Type 1, 6 as Type 2, 5 as Type 3, and 4 as Type 3S. The necessity of external carotid artery (ECA) ligation correlated with the tumor type. Type 3 tumors required ECA ligation in 50% of cases, while Type 1 and Type 2 tumors predominantly involved vascular preservation. Postoperative complications included vagal palsy in 28.5% of cases and first bite syndrome in 71.4%.
Conclusion
Accurate preoperative planning and a novel staging system can enhance surgical outcomes and reduce postoperative complications as validated by our study.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>39277827</pmid><doi>10.1007/s00405-024-08968-4</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-5871-8187</orcidid></addata></record> |
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| subjects | Adult Aged Cranial Nerve Neoplasms - diagnostic imaging Cranial Nerve Neoplasms - pathology Cranial Nerve Neoplasms - surgery Female Head and Neck Head and Neck Neoplasms - diagnostic imaging Head and Neck Neoplasms - pathology Head and Neck Neoplasms - surgery Head and Neck Surgery Humans Ligation Magnetic Resonance Imaging - methods Male Medicine Medicine & Public Health Middle Aged Neoplasm Staging Neurilemmoma - diagnostic imaging Neurilemmoma - pathology Neurilemmoma - surgery Neurosurgery Otorhinolaryngology Postoperative Complications Retrospective Studies Tomography, X-Ray Computed - methods Young Adult |
| title | Comprehensive analysis of radiological and surgical predictors in cervical sympathetic schwannomas: a novel staging approach and its implications |
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