- •Schwannomas of the hypoglossal nerve account for a very small percentage of non-vestibular schwannomas.
- •Current evidence suggests overall favorable outcomes with surgical resection of hypoglossal schwannomas.
- •A large percentage of patients (67%) experience mild and usually well-tolerated neurologic deficit.
Schwannomas of the hypoglossal nerve are rare and account for a very small percentage of non-vestibular schwannomas.
In this systematic review of the literature, we examined the epidemiology, symptomatology, management, and outcomes of patients with hypoglossal schwannomas.
The electronic database Pubmed was searched for all reports of hypoglossal schwannomas with descriptions of symptoms, management, and outcome characteristics. Data was extracted from each study and compiled in a spreadsheet. Continuous variables were reported as means and medians. Categorical variables were reported as proportions. Additional analysis was not done due to inconsistent reporting of outcomes and small sample sizes.
A total of 59 studies (94 total individual cases) were included. 64% of patients were female with mean age of 44.6 years. The majority were intracranial/extracranial (50%). The most common symptoms were tongue deviation or speech disturbance (38%) and headaches (33%). Hypoglossal nerve dysfunction was present in 80% of patients. Surgical excision was performed in 93%, with a 15% complication rate. Evidence of residual mass after surgery was noted in 29%. Permanent hypoglossal nerve deficits occurred in 67%. Recurrence of tumor burden was reported in 6 studies, with median time to recurrence of 16.5 months.
Current evidence suggests overall favorable outcomes with surgical resection of hypoglossal schwannomas, with a large percentage of patients experiencing mild and usually well-tolerated neurologic deficit. Limitations of this study include the use of retrospective data taken from case reports/series with highly selected patients, selective reporting, and absence of control groups.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Clinical Neuroscience
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Neurilemmoma (schwannoma) of the hypoglossal nerve.Plast Reconstr Surg Transplant Bull. 1962; 30: 95-98
- Vestibular schwannoma (acoustic neuroma). Consensus development conference.Neurosurgery. 1992; 30: 962-964
- Isolated hypoglossal nerve schwannoma: an uncommon presentation of schwannoma.J Clin Diagn Res. 2015; 9 (TJ01-2)
- Management of hypoglossal schwannomas: single institutional experience of 14 cases.J Neurol Surg Part B Skull Base. 2014; 75: 159-164
- Synchronous schwannomas of the hypoglossal nerve and cervical sympathetic chain.AJR Am J Roentgenol. 1998; 171: 1505-1507
- Jugular foramen schwannomas.J Neurosurg. 1984; 60: 1045-1053
- Schwannoma of the hypoglossal nerve: review of the literature based on an illustrative case.Mol Clin Oncol. 2017; 7: 288-294
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.BMJ (Clinical research ed). 2009; 339b2535
- The surgical management of symptomatic benign peripheral nerve sheath tumors of the neck and extremities: an experience of 442 cases.Neurosurgery. 2017; 81: 568-580
- Diagnosis and management of extracranial head and neck schwannomas: a review of 27 cases.Int J Otolaryngol. 2013; 2013973045
- Gamma Knife surgery for nonvestibular schwannomas: radiological and clinical outcomes.J Neurosurg. 2012; 116: 66-72
- Microsurgical management of hypoglossal schwannomas over 3 decades: a modified grading scale to guide surgical approach.Neurosurgery. 2011; 69 (ons121-40; discussion ons40)
- A case of schwannoma of the submandibular region.Open Dentist J. 2018; 12: 12-18
- Collet-sicard syndrome with hypoglossal nerve schwannoma: a case report.Ann Rehabil Med. 2017; 41: 1100-1104
- Single-stage total resection of giant dumbbell-shaped hypoglossal schwannoma: a case report.Acta Neurochir (Wien). 2018; 160: 727-730
- Hypoglossal schwannoma of neck: case report and review of literature.World Neurosurg. 2018; 110: 240-243
- Spontaneous regression of a hypoglossal neurinoma: case report and review of the literature.World Neurosurg. 2017; 105 (1033.e7-.e9)
- Excision of hypoglossal neurinoma by condyle sparing suboccipital keyhole approach.Asian J Neurosurg. 2017; 12: 120-122
- Schwannoma of the descending loop of the hypoglossal nerve: case report.Int J Surg Case Rep. 2017; 34: 20-22
- Solid-cystic hypoglossal nerve schwannoma with fluid-fluid level: a rare case report.J Clin Diagn Res. 2016; 10 (TD06-TD8)
- Hypofractionated stereotactic radiotherapy for dumbbell-shaped hypoglossal schwannomas: two cases of long-term follow-up and a review of the literature.Mol Clin Oncol. 2016; 5: 371-374
- Giant recurrent dumbbell-shaped hypoglossal schwannoma in an elderly male: a case report.Oncol Lett. 2016; 11: 283-286
- Hypoglossal schwannoma of parapharyngeal space: an unusual case report.J Maxillofac Oral Surg. 2015; 14: 73-76
- A case of malignant peripheral nerve sheath tumor of the hypoglossal nerve after stereotactic radiosurgery treatment.J Neurol Surgery Rep. 2014; 75: e42-e46
- Unusually large quiescent ancient schwannoma of hypoglossal nerve.Indian J Dent Res. 2013; 24: 768-771
- Spontaneous regression of a cystic hypoglossal schwannoma causing unilateral tongue atrophy.Br J Neurosurg. 2014; 28: 133-134
- Hypoglossal schwannoma presenting as hemi-atrophy of the tongue.Neurol India. 2013; 61: 324-325
- Using a modified far-lateral approach to remove hypoglossal neurilemmomas: notes on technique.J Neurosurg. 2013; 118: 657-668
- Isolated hypoglossal schwannoma in a 9-year-old child.J Neurosurg Pediatr. 2012; 10: 130-133
- Hypoglossal nerve schwannoma with intratumoral hemorrhage.Brain Tumor Pathol. 2012; 29: 43-46
- Hypoglossal schwannoma masquerading as a carotid body tumor.Case Rep Otolaryngol. 2012; 2012842761
- Plexiform hypoglossal schwannoma of the tongue and the submandibular region.J Craniofac Surg. 2012; 23: 1563-1565
- Schwannoma originating from lower cranial nerves: report of 4 cases.Nagoya J Med Sci. 2012; 74: 199-206
- Surgical treatment of dumbbell-shaped hypoglossal schwannoma via a pure endoscopic transoral approach.Acta Neurochir (Wien). 2012; 154 (discussion 75): 267-275
- Endoscopic transoral approach for extracranial hypoglossal schwannoma.ORL J Otorhinolaryngol Relat Spec. 2011; 73: 282-286
- Large cystic hypoglossal schwannoma with fluid-fluid level: a case report.Skull Base. 2010; 20: 193-197
- Intraoperative monitoring during surgery for hypoglossal schwannoma.J Clin Neurosci. 2010; 17: 1053-1056
- A cylindrical extracranial cranial base neurinoma of the hypoglossal nerve: a rare tumor with a rare localization: case report.Neurosurgery. 2009; 65 (discussion E3): E212-E213
- Surgical approach for hypoglossal schwannomas to prevent deformity of the atlanto-occipital joint.Acta Neurochir (Wien). 2009; 151: 575-579
- Hypoglossal schwannoma-successful reinnervation and functional recovery of the tongue following tumour removal and nerve grafting.Acta Neurochir (Wien). 2009; 151 (discussion 41): 837-841
- Extradural dumbbell schwannoma of the hypoglossal nerve: a case report with review of the literature.Surg Neurol. 2008; 70 (discussion S1:8-9.): 34-38
- Fatal delayed post-operative cerebral venous thrombosis after excision of hypoglossal nerve schwannoma.Acta Neurochir (Wien). 2008; 150 (605–9; discussion 9)
- Intradural microsurgery and extradural gamma knife surgery for hypoglossal schwannoma: case report and review of the literature.Minim Invasive Neurosurg. 2007; 50: 374-378
- A case of intracranial hypoglossal neurinoma without hypoglossal nerve palsy: operative view of the preserved rostral trunk.Minim Invasive Neurosurg. 2007; 50: 296-299
- Neurinoma of the hypoglossal nerve in the submandibular space: case report and review of the literature.Acta Neurochir (Wien). 2007; 149 (discussion 52): 949-952
- Hypoglossal neurinoma extending intra- and extracranially: case report.Surg Neurol. 1996; 45: 172-175
- Dumbbell-shaped hypoglossal schwannoma in an elderly woman: a clinical dilemma.Surg Neurol. 2005; 63 (discussion 8): 526-528
- Extracranial hypoglossal schwannoma.Neurology. 2003; 60 (E11)
- Dumbbell-shaped hypoglossal schwannoma. A case report.Magn Reson Imaging. 2003; 21: 155-158
- Hypoglossal neurinoma presenting with intratumoral hemorrhage.J Clin Neurosci. 2002; 9: 716-719
- Hypoglossal schwannoma in the submandibular space.J Laryngol Otol. 2002; 116: 63-64
- Cellular dumbbell schwannoma of the hypoglossal nerve presenting without hypoglossal nerve palsy.Clin Neurol Neurosurg. 2000; 102: 40-43
- Hypoglossal neurinoma–two case reports.Neurol Med Chir. 2000; 40: 489-493
- Navigated dorsolateral suboccipital transcondylar (NADOSTA) approach for treatment of hypoglossal schwannoma. Case report and review of the literature.Clin Neurol Neurosurg. 2005; 107: 236-242
- Sublingual hypoglossal neurilemmoma. Case report.Austr Dental J. 1998; 43: 311-314
- Intracranial hypoglossal neurinoma without preoperative hypoglossal nerve paresis–case report.Neurol Med Chir. 1996; 36: 384-387
- Neck schwannoma masquerading as a carotid body tumor.J Clin Diagnos Res. 2011; 5: 654-656
- Hypoglossal schwannoma.Ann Otol Rhinol Laryngol. 1995; 104: 490-492
- Surgical management of transcranial hypoglossal schwannomas.Am J Otolo. 1995; 16: 451-456
- Intracranial schwannoma of the hypoglossal nerve.Arch Neurol. 1984; 41: 502-505
- Twelfth nerve neurilemmoma occurring in the middle ear.Otolaryngology–head Neck Surg. 1982; 90: 662-664
- Hypoglossal neurilemmoma: case report and review of the literature.Neurosurgery. 1982; 10: 617-620
- Intracranial hypoglossal schwannoma as an unusual cause of facial nerve palsy. Case report.J Neurosurg. 1982; 56: 420-423
- Dumb-bell neurinoma of the hypoglossal nerve.J Neurol Neurosurg Psychiatry. 1973; 36: 592-595
- Intracranial neurilemmoma of the hypoglossal nerve. Review and case report.Neurology. 1966; 16: 709-713
- Neurinoma of the intracranial portion of the hypoglossal nerve. Review and case report.J Neurosurg. 1962; 19: 248-250
- Intracranial neurinoma of the hypoglossal nerve; successful removal; case report.J Neurosurg. 1949; 6: 333-336
- Hypoglossal canal lesions: Distinctive imaging features and simple diagnostic algorithm.AJR Am J Roentgenol. 2017; 209: 1119-1127
- Extracranial head and neck schwannomas–a 10-year review.Auris Nasus Larynx. 2007; 34: 353-359
Published online: November 21, 2018
Accepted: November 12, 2018
Received: October 13, 2018
© 2018 Elsevier Ltd. All rights reserved.