Cervical sympathetic chain schwannoma

Schwannomas are benign, slow-growing tumors that arise from Schwann cells of the nerve sheath. Those originating from the sympathetic cervical chain are rare. Herein, we present three cases of cervical sympathetic chain schwannoma (CSCS) and describe our experience with the clinical presentation, surgical management, and outcomes of patients with this pathology. All three patients were found to have a pulsatile, non-tender mass located at the level of the angle of the mandible without cervical nerve function deficit. On imaging study, the location of the mass between the prevertebral muscle and carotid artery with outward displacement of the carotid sheath is a typical characteristic of CSCS. Operative excision and sacrifice of a portion of the sympathetic chain remains the treatment of choice. Postoperative Horner's syndrome is predictable and vagus nerve dysfunction or first bite syndrome is also possible.