Perineural Spread in Noncutaneous Head and Neck Cancer: New Insights into an Old Problem

Moran Amit, Ayelet Eran, Salem Billan, Eran Fridman, Shorook Na'ara, Tomer Charas, Ziv Gil

Research output: Contribution to journalReview articlepeer-review

34 Scopus citations


Head and neck malignancies have the propensity to invade nerves. Perineural tumor invasion is common, with some series reporting rates of 30 to 100%. Squamous cell carcinoma and adenoid cystic carcinoma are the most commonly involved tumors. The most commonly involved nerves are the trigeminal (cranial nerve [CN] V) and facial (CN VII) and their branches. Neural spread away from a tumor is encountered less often and usually causes specific symptoms such as pain, muscle weakness, and atrophy, depending on the involved nerves. While clinical symptoms and physical examination may suggest the presence of neural invasion, specific imaging modalities such as fat-suppressed T1-weighted magnetic resonance images, should be utilized to identify perineural tumor spread in its early phases. Perineural tumor spread should be considered and addressed in the treatment planning of patients with head and neck or skull base cancers as it can influence the extent of surgery, and the dosage and fields of radiation therapy. In the current review, we discuss the clinical course of perineural tumor spread and its therapeutic implications.

Original languageEnglish (US)
Pages (from-to)86-95
Number of pages10
JournalJournal of Neurological Surgery, Part B: Skull Base
Issue number2
StatePublished - Feb 26 2016


  • adenoid cystic carcinoma
  • base of skull
  • head and neck cancer
  • neural
  • squamous cell carcinoma
  • survival

ASJC Scopus subject areas

  • Clinical Neurology


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