Abstract / Summary
Abstract Objective To describe the clinical features, surgical management, and postoperative neurological outcomes of a giant right supraclavicular schwannoma extending toward the cervical intervertebral foramen. Particular attention was paid to the tumor’s close relationship with the surrounding neurovascular structures. Methods We retrospectively reviewed the clinical data, imaging findings, surgical procedures, pathological findings, postoperative course, and follow-up of a patient with a giant right supraclavicular schwannoma. The surgical and perioperative management was evaluated with regard to the tumor’s relationship to adjacent neurovascular structures, intraoperative blood loss, postoperative neurological function, wound and drainage status, and recovery. The case was reported in accordance with the CARE guidelines[1]. Results A 47-year-old woman was admitted after an incidentally detected neck mass had persisted for more than 1 month. Imaging revealed a mixed-density mass with abnormal signal in the right supraclavicular region, measuring approximately 58 mm at its largest diameter. The lesion extended toward the right intervertebral foramen, with prominent vessels surrounding the mass. Preoperative biopsy showed a spindle cell tumor consistent with schwannoma. Immunohistochemistry was positive for S-100 and SOX10, with a Ki-67 index of approximately 3%[11]. The patient underwent right cervical soft-tissue tumor resection, vascular and nerve exploration and neurolysis, and random-pattern fascial flap reconstruction. Intraoperative blood loss was approximately 400 ml, and 1.5 U of packed red blood cells and 220 ml of plasma were transfused. A wound drain was placed after surgery. Postoperative management included cervical compression with a salt bag, monitoring of the wound and drainage, and serial neurological assessments. No postoperative wound bleeding or cervical hematoma developed. Numbness in the distal phalanges of the right hand gradually improved, muscle strength remained grade V, and distal limb perfusion was preserved. The patient was discharged on postoperative day 5 with satisfactory wound healing. At 1 month after surgery, cervical MRI showed slight enlargement of the right C6/7 nerve root. The patient had no cervical scar tenderness or other significant symptoms. Conclusion Giant supraclavicular schwannomas can be difficult to remove because of their deep location and close proximity to major vessels, peripheral nerves, and cervical nerve roots. Preoperative imaging, careful dissection, and postoperative neurological assessment are important for reducing complications and preserving neurological function. Perioperative management should be tailored to the tumor anatomy and intraoperative findings rather than based solely on routine risk scores[5][6][7][8][9][10].