This paper presents a delightfully simple and sensible hypothesis for the management of benign schwannomas in the head and neck region. They have taken the approach used for the management of vestibular schwannomas and used the same principles to assess cervical schwannomas. The group from the University of California undertook a 20-year retrospective review of patients with pathologic or imaging characteristics of cervical schwannoma. These patients required a histologic diagnosis of cervical schwannoma or at least two imaging studies consistent with a radiographic diagnosis. The authors only identified 13 patients that fulfilled the inclusion criteria. They present results showing a statistical difference in the growth rates between those that underwent surgical intervention when compared to observation or gamma knife treatment. The benign nature of these masses and the morbidity associated surgical intervention means that serial imaging would be an acceptable management strategy in those with minimal symptoms. This paper begins to try to quantify where the balance between good and harm may lie in the treatment we offer. The work presented sets the groundwork for a larger assessment of practice over a number of centres. The findings here will add to MDT discussions. The rarity of these masses means highly powered trial data is unlikely to emerge.

Volumetric growth of cervical schwannoma as a predictor of surgical intervention.
Alemi AS, Heaton CM, Ryan WR, et al.
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Stuart Burrows

FRCS (ORL-HNS), Wellington Regional Hospital, Newtown, Wellington, New Zealand.

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