Perineural spread (PNS) of head and neck cancers is a well-recognised form of tumour dissemination. (1) The management of these complex cases includes a combination of surgery and radiotherapy. It is well recognized in other areas of the body, that “stump neuromas” may occur at the site of a transected or damaged nerve. (2) This investigation aims to evaluate the rate and characteristics of stump neuroma formation in cranial nerves following skull base resection for PNS. We also aim to describe features that can be...

Patients identified from existing hospital database as having undergone surgery for large nerve PNS between 2000 and 2015 were retrospectively reviewed. The recommended MRI schedule for follow up of patients after surgical resection of large nerve skull base PNS is as follows: initial scan at 3 months after surgery (baseline scan), then at 6 and 12 months after surgery, followed by yearly scans until the 5 year mark. Pre-operative and post-operative MRIs were reviewed by two head and neck radiologists to identify any abnormal enhancement...

132 patients were identified as meeting inclusion criteria, with a male predominance (82%) and an average age of 62.7 years at surgery. Surgical resection margins were identified as clear in 51.1% of patients. The most common pathology was SCC (86%) and the majority of patients underwent post-operative radiotherapy (87%). There were 73 patients (55%) that had more than 2 years of follow up. There were 43 patients (33%) with stump neuromas identified from this group; with the majority of these patients (51%) having features in...

In conclusion, stump neuromas do arise in transected cranial nerves at the skull base but can be difficult to distinguish from central recurrence or residual disease in the early post-operative period. It is important to correlate with the pre-operative imaging and pathology as patient's with positive margins are likely to be of higher risk for central progression. In patient's with nodular enhancement at the site of nerve resection, stability or reduced enhancement over time is reassuring and is suggestive of a stump neuroma.

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