Schwannoma of cervical sympathetic chain: assessment and management

Schwannoma arising from the cervical sympathetic chain is an uncommon benign nerve tumour. This tumour most often presents as an asymptomatic solitary neck mass, with slow-growing and rare malignant degeneration. Definitive pre-operative diagnosis may be difficult and investigations are not usually helpful. The carotid artery and internal jugular vein may be displaced anterior-laterally. Diagnosis relies on clinical suspicion and confirmation is often obtained by means of surgical pathology. Surgical excision is the treatment of choice for this tumour, with recurrence being rare. Homer's syndrome is a common post-operative neurological consequence, but does not appear to cause problems to the patient. The case is described of a 42-year-old male who presented an asymptomatic left neck mass. Diagnostic studies included computed tomography, magnetic resonance imaging, and ultrasound which confirmed a circumscribed mass in the upper left portion of the neck next to the thyroid gland. The mass was excised through a transverse left cervical skin incision. Post-operatively the patient showed clinical findings of Horner's syndrome. The pathologic and radiological evaluations, treatment and postoperative complications of this neoplasm are discussed.