1400 - Management of Chronic Neuropathic Cervical Pain Following Nerve Sheath Tumor Resection and Radiation

Case Diagnosis: Chronic superficial cervical plexopathy secondary to nerve injury and radiation fibrosis in a young adult status post resection and radiation for left carotid triangle nerve sheath sarcoma. Symptoms were consistent with persistent neuropathic pain, characterized by localized allodynia, radiation to the anterior chest, and refractory response to standard therapies.

Case Description: A 33-year-old male developed chronic neuropathic pain after resection and radiation of a left cervical nerve sheath tumor. Pain was localized to the surgical scar and radiated to the left pectoralis, with significant allodynia and sleep disturbance. Physical therapy and topical agents were ineffective. An ultrasound-guided superficial cervical plexus block yielded transient but complete relief, confirming a neuropathic etiology. Imaging ruled out recurrence or structural pathology. A multidisciplinary plan was developed, including further imaging, botulinum toxin injection, and specialized rehabilitation for radiation fibrosis and nerve entrapment.

Discussions: This case illustrates the diagnostic and therapeutic complexity of post-surgical, radiation-associated neuropathic pain. Direct nerve trauma combined with radiation-induced fibrosis can result in persistent nerve entrapment, altered nociception, and functional decline. In this patient, imaging and nerve block findings localized symptoms to the superficial cervical plexus. Limited benefit from standard therapies highlights the need for multimodal management. Botulinum toxin may offer therapeutic benefit through both muscle relaxation and antinociceptive mechanisms, but data remains limited. Early recognition and multidisciplinary care are critical to improving quality of life in this under-recognized cancer survivorship challenge.

Conclusions: Persistent cervical neuropathic pain following nerve sheath tumor treatment may be severe, functionally limiting, and resistant to conventional care. Diagnostic nerve blocks can aid localization. This case supports a tailored, multidisciplinary strategy which includes interventional, pharmacologic, and rehabilitative approaches; botulinum toxin is under consideration as a promising but underused option in radiation-associated neuropathic pain.