A neurofibroma affecting the first right cervical sympathetic ganglion and entering the jugular foramen of the skull base.

The case of a 27 year old male patient is presented. He had been complaining for three months prior to his initial medical examination of severe pulsating headache in the right occipital region, propagating toward the right parietal and temporal regions, occasionally extending along the neck to the right shoulder. The pain subsequently spread over the right tonsil, the voice became hoarse and the patient experienced difficulties in swallowing. On admission to our Department we found: persistent attacks of headache, dysphonia, dysphagia, the palatine arch was slow during phonation. The right pharyngeal reflex was absent, there was pain on palpation over the right occipital bone and the antero-lateral region of the neck, as well as hypotrophy of the right sternocleidomastoid muscle. Selective right carotid arteriogram was performed--the A/P view revealed lateral displacement of the right internal carotid artery 3 cm above the bifurcation, while on lateral view the artery was pushed forward. Computed tomography of the neck with bolus contrast enhancement showed a space-occupying lesion which caused asymmetry of right pharyngeal valleculae. During surgery the tumor was found to have a spindleform shape, to emerge from the jugular foramen and to involve within its capsule the first cervical sympathetic ganglion. After enlarging the jugular foramen we achieved total extirpation of the tumor along with the first right sympathetic ganglion. The histological characteristics of the specimen defined it as neurofibroma and neural ganglion. The headache subsided in the postoperative period, recovery of the voice without dysphonia was also noted. A month later the fibrillar contractions of the tongue disappeared.