Cervical Sympathetic Chain Schwannoma in a Child: Anesthesia Concerns

Cervical sympathetic chain schwannomas are rare benign tumors, extremely uncommon in children, and may present diagnostic and anesthetic challenges due to their proximity to the airway and major vascular structures. We report the case of a 12-year-old boy with a progressively enlarging left-sided cervical mass associated with recent dysphagia and odynophagia. Imaging suggested a vagal schwannoma within the carotid sheath, displacing carotid arteries, internal jugular vein, and trachea, raising concerns for airway distortion and potential hemodynamic instability during surgery. Anticipating a difficult airway and autonomic disturbances, the anesthesia team prepared a comprehensive strategy including a difficult airway cart and readiness for emergency tracheostomy. Standard monitoring was supplemented with invasive arterial blood pressure monitoring. Induction and tracheal intubation were successfully performed using video laryngoscopy, and anesthesia was maintained with careful titration of inhalational agents and neuromuscular blockade. Surgical excision revealed the tumor to originate from the cervical sympathetic chain rather than the vagus nerve. The mass was excised completely with preservation of adjacent nerves and vessels, and the child remained hemodynamically stable throughout the procedure. Recovery was smooth, with no airway compromise, though mild ptosis and miosis consistent with Horner's syndrome were noted. This case underscores the rarity of pediatric cervical sympathetic chain schwannomas and highlights the need for meticulous anesthetic planning to address airway distortion, vascular involvement, and potential autonomic instability. Early anticipation and multidisciplinary coordination are key to achieving safe surgical and functional outcomes in such rare pediatric head and neck tumors.