An unexpected complication of hypoglossal schwannoma surgery: Cerebrospinal fluid leakage—A case report and literature review

• Published in: Head & neck Vol. 46; no. 1; pp. E6 - E9
• Main Authors: Asya, Orhan, Kuyumcu, Ömer Faruk, Gündoğdu, Yavuz
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01-01-2024; Wiley Subscription Services, Inc
• Subjects: avulsion; Brain stem; Carotid artery; Cerebrospinal fluid; cerebrospinal fluid leakage; Hypoglossal nerve; hypoglossal schwannoma; Leakage; Literature reviews; Magnetic resonance imaging; neck tumor; Schwann cells; surgery; Tumors; avulsion; hypoglossal schwannoma; neck tumor; cerebrospinal fluid leakage; surgery
• ISSN: 1043-3074; 1097-0347; 1097-0347
• DOI: 10.1002/hed.27554

Background
Extracranial hypoglossal schwannoma is a rare tumor primarily treated with surgical excision. This article aims to highlight the potential for unexpected complications intraoperatively, such as cerebrospinal fluid leakage from skullbase to neck.
Methods
A previously healthy 23‐year‐old male presented with tongue numbness. Magnetic resonance imaging revealed a 17 × 20 mm nodular lesion adjacent to the cervical segment of the internal carotid artery. Surgical excision was scheduled due to suspicion of a neurogenic tumor.
Results
Intraoperatively, despite careful handling, cerebrospinal fluid leakage was observed. Manipulation of the mass caused detachment of proximal nerve fibers, potentially indicating avulsion of the hypoglossal nerve from the brainstem or nearby. Clear fluid leakage from the skull base was also noted.
Conclusion
Thorough preoperative evaluation and patient education regarding potential complications are crucial. This article presents an unexpected complication encountered during surgical excision of extracranial hypoglossal schwannoma, emphasizing the need for awareness and preparedness in such cases.