Management strategies for cervical schwannomas: a comprehensive review

OBJECTIVE The authors’ goal was to provide a comprehensive overview of the pathophysiology, clinical presentation, and management strategies of cervical schwannomas. METHODS A thorough literature review of diagnostic imaging techniques, particularly MRI, was conducted to identify characteristic features of cervical schwannomas, such as avid Gd uptake and scalloping. Histological and immunohistochemical analyses, including stains for S100 and SOX10, were evaluated to confirm the diagnosis and differentiate schwannomas from other tumors, such as meningiomas and metastatic disease. Various surgical approaches, including posterior midline, anterolateral, and far lateral, were assessed as described in the literature for their effectiveness in resecting tumors while preserving neurological function. The role of stereotactic body radiation therapy (SBRT) was also examined for patients who were ineligible for surgery. RESULTS Imaging and histological analyses effectively distinguish cervical schwannomas from other spinal tumors. Resection remains the cornerstone of treatment, with tailored approaches to ensure optimal tumor removal and preservation of neurological function. Subtotal resection poses a higher recurrence risk than gross-total resection, necessitating regular MRI monitoring. SBRT offers a promising nonsurgical alternative because it achieves good local control and symptomatic relief. However, outcomes of SBRT vary, especially in patients with neurofibromatosis type 2. CONCLUSIONS A multidisciplinary approach is crucial for managing cervical schwannomas, integrating resection, regular monitoring, and nonsurgical treatments such as SBRT to optimize patients’ outcomes and quality of life.