Angiographic diagnosis and management of head and neck schwannomas

Schwannomas are tumors derived from nerve sheath cells, which are often located in the head and neck, including the CNS. Although a definitive vascular pattern has been previously characterized for these lesions, preoperative embolization of the more vascular schwannomas has not been described. In a review of eight patients with schwannomas who underwent angiography at our institution since 1987, a characteristic vascular pattern became apparent that helped distinguish these lesions from other lesions of the head and neck. The lesions were moderately vascular with tortuous tumor vessels. Scattered, small puddles of contrast medium seen in the mid-arterial, capillary, and venous phases were believed to be characteristic of these lesions. Multiple feeding vessels were noted in all but one case, but these were only minimally enlarged. No arteriovenous shunting or vascular encasement was identified. Six of eight lesions were embolized with significant devascularization and no morbidity or mortality. In patients with head and neck tumors whose angiographic findings include a pattern of moderate hypervascularity, tortuous tumor vessels, and, in particular, scattered contrast puddles without arteriovenous shunting or vascular encasement, schwannoma should be suspected. Embolization is a useful and safe presurgical adjunct in the treatment of vascular schwannomas.