Perineural Tumor Spread along the Cervical Plexus in Head and Neck Cancer: Imaging Features and Clinical Characteristics from a Single-Center Case Series

Perineural tumor spread of head and neck cancer has been associated with poor prognosis and is a diagnostic challenge for neuroradiologists who may be unfamiliar with neural anatomy. Although much of the literature has focused on understanding anatomy and perineural tumor spread along the cranial nerves, there has been relatively little focus on the cervical plexus, due to a lack of familiarity with its complex anatomy or recognition that perineural tumor spread can occur along its vast neural network. Consequently, perineural tumor spread in the cervical plexus is underrecognized and underdiagnosed. We present our institution's experience with perineural tumor spread along the cervical plexus from various head and neck cancers. This paper highlights the key anatomy of the cervical plexus and describes the imaging and clinical features of its perineural tumor spread to support timely diagnosis and management.