[Preliminary study on preoperative diagnosis of cervical sympathetic trunk and vagus nerve origin schwannoma based on...

Objective:To establish a diagnostic model for differentiating cervical sympathetic trunk from vagus neurinoma based on objective imaging data. Methods:The imaging data of patients with cervical sympathetic trunk and vagus neurinoma admitted to the Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital from January 2008 to November 2023 and obtained from the Radiopaedia database were retrospectively analyzed. Mimics 21 software was used to process the imaging data. Imaging parameters were measured, including carotid sheath vascular displacement, tumor size, jugular arteriovene-tumor intersection, and carotid intrasheath vascular spacing, to identify the indicators of cervical sympathetic trunk and vagus nerve origin before surgery. Results:A total of 33 patients were included and divided into vagus group（n=25） and cervical sympathetic trunk group（n=8）. Analysis of imaging features showed that lateral displacement of the internal carotid artery（P=0.002） and midline displacement（P=0.018） were significantly different in the vagus and cervical sympathetic trunk groups. The jugular arterioveno-tumor intersection Angle was measured: 122.00°（99.20, 157.35）° and 52.60°（32.30, 87.00）° in the vagus and cervical sympathetic trunk groups, respectively（P=0.001）, and the total carotid/internal jugular arterio-internal jugular vein spacing: In vagus nerve group and cervical sympathetic trunk group, 34.20 mm（27.80, 43.40） mm and 21.95 mm（11.90, 30.90） mm, respectively, （P=0.004）. ROC curve analysis: When the jugular arteriovenous-tumor intersection Angle was used as the diagnostic index, the sensitivity and specificity of predicting the tumor as vagus nerve origin was 80.0% and 87.5%（AUC=0.865） when the Angle was greater than 94.20°. When the distance between the total carotid artery and internal jugular vein was greater than 32.8 mm, the sensitivity and specificity were 56.0% and 100.0%（AUC=0.835） for predicting the tumor as vagus nerve origin. When the two indexes were combined as diagnostic basis, AUC=0.885. Conclusion:Cervical stem sympathetic neurinoma is characterized by lateral displacement of internal carotid artery and consistent arteriovenous displacement, while vagus neurinoma is characterized by midline displacement of the internal carotid artery and arteriovenous separation displacement. Objective imaging data combined with the jugular arterioveno-tumor intersection and the total cervical/internal jugular arterio-internal jugular vein spacing are helpful for preoperative prediction of the nerve origin of the cervical sympathetic trunk and vagus nerve schwannoma. When the jugular arteriovenous-tumor intersection Angle is greater than 94.20°, and the total neck/internal jugular arteriovenous distance is greater than 32.80 mm, it indicates that the tumor originates from the vagus nerve.