Management strategies for cervical schwannomas: a comprehensive review

J Neurosurg Spine 42:650–658, 2025

The review discusses cervical schwannomas, focusing on their pathophysiology, clinical presentation, and management strategies, including surgical resection and stereotactic body radiation therapy (SBRT). It emphasizes the importance of a multidisciplinary approach for optimal patient outcomes and highlights the need for ongoing research.

Cervical schwannomas are benign tumors originating from Schwann cells, often occurring in the intradural, extramedullary space of the cervical spine.

MRI is the primary imaging modality for diagnosing schwannomas, characterized by avid Gd uptake and specific radiographic features.

Surgical resection is the main treatment approach, with gross-total resection preferred to minimize recurrence. Various surgical techniques are available depending on tumor location.

Stereotactic body radiation therapy (SBRT) is a viable alternative for patients who are not surgical candidates, offering good local control and symptomatic relief.

Histological analysis distinguishes schwannomas through specific features such as Antoni A and B areas and Verocay bodies. Immunohistochemical stains like S100 and SOX10 aid in diagnosis.

Multidisciplinary management is crucial, integrating surgical and nonsurgical options to optimize patient outcomes and quality of life.

Observation may be suitable for asymptomatic patients with slow-growing lesions, with regular monitoring to assess progression.

Malignant transformation into peripheral nerve sheath tumors is rare but possible, particularly in patients with NF1.