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Objectives: Tumors involving the vagus nerve are often clinically silent. We offer a case series with different clinical presentations and distinctive post-surgical sequelae that highlight some of the challenges associated with managing cervical vagal nerve tumors. Methods: Single-institution, retrospective review of patients with tumors involving the vagus nerve. We describe clinical presentations and postoperative sequelae of five patients who underwent surgical management of vagal nerve pathology with atypical presentation or subsequent clinical course. Results: Here, we present five patients treated at our institution for vagal tumors. In four of the five patients, the presenting symptoms resolved after surgery. Two patients presented with intractable neurogenic cough, and another two presented with autonomic symptoms, one with syncope/palpitations and the other with intractable sweating. The final patient presented with a rapidly enlarging vagal paraganglioma and developed intractable cough after resection. We present two patients with novel approach to vagal paragangliomas that underwent ligation of feeding blood supply without removing the tumor, resulting in resolution of an intractable cough in one patient and resolution of severe nighttime sweating in the other. Conclusion: Management of tumors associated with the cervical vagus nerve that present with symptoms or rapid growth poses a clinical dilemma. Consideration of the tumor origin with either enucleation of schwannomas or ligation of feeding vessels may preserve function while addressing the presenting symptoms. [ABSTRACT FROM AUTHOR]

Simultaneously diagnosing cervical sympathetic chain schwannoma, nodular goiter and parathyroid adenoma is a very rare event during clinical practice. We had the opportunity to find this unusual association on a female patient. While nodular goiter and parathyroid adenoma are more common diseases and easier to diagnose, identifying the etiology of a parapharyngeal space tumor remains a challenge and requires multiple imaging studies such as computed tomography scan, magnetic resonance imaging or angiography. A cervical sympathetic chain schwannoma, a carotid body tumor, a paraganglioma or a vagal schwannoma must be taken into account as possible diagnostic variants. Complaints such as Horner`s syndrome, hoarse voice or dysphagia may suggest a nerve originating tumor, but this is a rare situation. Only the surgical exploration is successful in detecting the tumor origin from the cervical sympathetic chain. Even so, the exact origin of the tumor cannot usually be detected without surgical exploration and removal of the piece or biopsies. Therefore, the pathological report of the specimen (adding or not immunohistochemistry tests) is mandatory to be able to confirm the diagnosis of schwannoma.

Simultaneously diagnosing cervical sympathetic chain schwannoma, nodular goiter and parathyroid adenoma is a very rare event during clinical practice. We had the opportunity to find this unusual association on a female patient. While nodular goiter and parathyroid adenoma are more common diseases and easier to diagnose, identifying the etiology of a parapharyngeal space tumor remains a challenge and requires multiple imaging studies such as computed tomography scan, magnetic resonance imaging or angiography. A cervical sympathetic chain schwannoma, a carotid body tumor, a paraganglioma or a vagal schwannoma must be taken into account as possible diagnostic variants. Complaints such as Horner`s syndrome, hoarse voice or dysphagia may suggest a nerve originating tumor, but this is a rare situation. Only the surgical exploration is successful in detecting the tumor origin from the cervical sympathetic chain. Even so, the exact origin of the tumor cannot usually be detected without surgical exploration and removal of the piece or biopsies. Therefore, the pathological report of the specimen (adding or not immunohistochemistry tests) is mandatory to be able to confirm the diagnosis of schwannoma. [ABSTRACT FROM AUTHOR]

Background and Objectives: Clinical management of vagal schwannoma is a real diagnostic and therapeutic challenge because the medical history and clinical examination are often non-specific and vagal nerve injury following surgical resection still represents an unsolved problem. The aim of this paper is to provide a case series along with a diagnostic and therapeutic algorithm for vagal schwannoma of the head and neck, combining our experience with clinical evidence available in the literature. Materials and Methods: We retrospectively analyzed a series of patients affected by vagal schwannoma who were treated between 2000 and 2020. In addition, a review of the literature on vagal schwannoma management was conducted. Based on the cases described and the literature review, we made a diagnostic and therapeutic algorithm for the management of vagal schwannoma. Results: We were able to identify 10 patients affected by vagal schwannoma and treated between 2000 and 2020. All patients presented with a painless, mobile, slow-growing lateral neck mass with onset varying from a few months to years. The preoperative diagnostic workup included ultrasound (US) in nine cases, computed tomography (CT) with contrast in six patients and magnetic resonance imaging (MRI) of the neck in seven cases. All patients included in this study were surgically treated. Conclusions: Vagal schwannoma management represents a true challenge for clinicians and surgery is currently the most effective therapeutic strategy. A multidisciplinary approach through the collaboration of otolaryngologist with other specialists is desirable to develop a tailored treatment plan for the patient. [ABSTRACT FROM AUTHOR]

Background: This study evaluates the outcomes of intracapsular enucleation using the retroauricular hairline incision (RAHI) approach for treating cervical vagal schwannomas., Methods: A longitudinal study was conducted on patients with cervical vagal schwannomas. Eleven patients who underwent RAHI-based enucleation were included. Preoperative imaging was performed using contrast-enhanced MRI. Postoperative evaluations assessed pain, neurological function, cosmetic outcomes, voice, and swallowing functions., Results: Eleven patients underwent surgery. The median tumor size was 4.6 cm. The median operation time was 42 min, with minimal bleeding. Common complications were earlobe numbness (45%) and temporary vocal cord paralysis (27%), which were resolved within a year. Cosmetic satisfaction was high, with median VAS scores of nine for scars and 10 for facial deformities. No significant dysphagia was found. No recurrences were observed over a median follow-up of 79 months., Conclusions: Intracapsular enucleation using the RAHI approach is a safe and effective method for treating cervical vagal schwannomas., (© 2024 Wiley Periodicals LLC.)

Cervical vagal schwannoma is a rare clinical entity that requires a different clinical approach than other neck swellings. Magnetic resonance imaging is the preferred initial diagnostic test. Complications may arise due to vagal stimulation in unsuspecting open biopsies. Surgical excision with perioperative vagal monitoring is recommended for the treatment of vagal schwannomas. [ABSTRACT FROM AUTHOR]

Purpose: Different therapeutic strategies have been developed to improve surgical and functional outcome of parapharyngeal space (PPS) neoplasms. The transparotid–transcervical approach (TTa) is a valid surgical option to manage most PPS tumors. Its short- and long-term disease control and cranial nerve (c.n.) function outcomes have not been discussed extensively. Methods: All patients who underwent TTa over a 10-year period at a tertiary academic center were retrospectively reviewed. Data about preoperative imaging, clinical presentation, tumor's size, location and histology, and postoperative oncological and functional results were registered and analyzed. Results: Sixty patients matched the inclusion criteria. Most of the lesions were benign (71.7%), involved the prestyloid PPS (63.3%) and measured more than 30 mm (75%). Fifty-two (86.7%) lesions were resected en-bloc. Clear margins were achieved in 91.7% of the cases, with positive margins solely associated with malignancy (p = 0.008). Post-operative c.n. function was satisfactory, with X c.n. function significantly associated with the retrostyloid location (p =.00) and neurogenic tumors (p = 0.02). Local disease-control was achieved in 96% of the cases after a median follow-up of 46 (± 19.7–82.0 IQR) months. Conclusions: The TTa was safe and effective, achieving a satisfactory local control rate. Nevertheless, malignancies maintain a higher rate of positive margin due to their infiltrative nature and the complex anatomy of the PPS. In such cases, multiportal approaches might be more effective. However, post-operative c.n. function remained satisfactory, irrespective of lesions' size and histopathologic behavior. A higher X c.n. deficit rate was observed in retrostyloid and neurogenic lesions. [ABSTRACT FROM AUTHOR]

Background and Objectives: Clinical management of vagal schwannoma is a real diagnostic and therapeutic challenge because the medical history and clinical examination are often non-specific and vagal nerve injury following surgical resection still represents an unsolved problem. The aim of this paper is to provide a case series along with a diagnostic and therapeutic algorithm for vagal schwannoma of the head and neck, combining our experience with clinical evidence available in the literature. Materials and Methods: We retrospectively analyzed a series of patients affected by vagal schwannoma who were treated between 2000 and 2020. In addition, a review of the literature on vagal schwannoma management was conducted. Based on the cases described and the literature review, we made a diagnostic and therapeutic algorithm for the management of vagal schwannoma. Results: We were able to identify 10 patients affected by vagal schwannoma and treated between 2000 and 2020. All patients presented with a painless, mobile, slow-growing lateral neck mass with onset varying from a few months to years. The preoperative diagnostic workup included ultrasound (US) in nine cases, computed tomography (CT) with contrast in six patients and magnetic resonance imaging (MRI) of the neck in seven cases. All patients included in this study were surgically treated. Conclusions: Vagal schwannoma management represents a true challenge for clinicians and surgery is currently the most effective therapeutic strategy. A multidisciplinary approach through the collaboration of otolaryngologist with other specialists is desirable to develop a tailored treatment plan for the patient.

Abstract We describe an unusual case of a young girl presenting with a large vagal schwannoma necessitating a transcervical‐mandibulotomy approach for total tumor resection. The presentation is unique due to the size of the lesion, the patient’s age, the operative approach, and molecular pathology.

Background: Synovial sarcomas (SS) are aggressive soft tissue malignancies that classically affect the lower extremities of young patients. They are particularly rare in the head/neck region, comprising

We describe an unusual case of a young girl presenting with a large vagal schwannoma necessitating a transcervical‐mandibulotomy approach for total tumor resection. The presentation is unique due to the size of the lesion, the patient's age, the operative approach, and molecular pathology. [ABSTRACT FROM AUTHOR]

Cervical cystic vagal schwannomas sometimes mimic lateral neck cysts because of their extremely rare cystic appearance. Accurate diagnosis of this tumor and preservation of neural function are important because permanent neural injury may occur in patients with cervical schwannomas. During surgery, tumor enucleation of the true capsule of the tumor protects the nerve of origin. In this report, we discuss the case of a 27-year-old woman with cervical cystic vagal schwannoma mimicking a lateral neck cyst, who underwent successful tumor enucleation without suffering permanent neurological deficits. This case report aimed to present the extremely rare cystic changes that may occur in cervical schwannomas, and to improve diagnostic accuracy in relation to this disease. Herein, we discuss the details of enucleation, the methodology of which has not been standardized, and advocate the need for surgery in accordance with the pathogenesis of schwannoma. [ABSTRACT FROM AUTHOR]

Schwannoma is a benign peripheral nerve sheath tumour that arises from the uncontrolled proliferation of Schwann cells. Intracranial and extracranial vagus nerve schwannoma is an extremely rare entity that poses a surgical challenge due to its delicate location in the cerebrum and parapharyngeal space adjacent to major neck vessels. This report describes a unique case of a 42 years old female with left dumbbell vagus nerve schwannoma, involving both the intracranial and extracranial portion of the left vagus nerve, extending into the parapharyngeal space. She underwent a two-stage surgery in which intracranial vagus schwanomma was debulked initially, and excision of the extracranial schwanomma in the parapharyngeal space was performed in a later setting via a transcervical approach. [ABSTRACT FROM AUTHOR]

Background: Vagal schwannomas are rare, benign tumors of the head and neck. Nerve damage during surgical resection is associated with significant morbidity. A new technique of continuous intraoperative nerve monitoring (IONM) that allows for real‐time intraoperative feedback has recently been used for thyroid and cervical spine surgeries but has not previously been used in vagal schwannoma surgery. Methods: Case series of three patients who underwent vagal schwannoma excision utilizing this novel IONM technique. The recurrent laryngeal and vagus nerves were monitored via the laryngeal adductor reflex (LAR) using an electromyographic endotracheal tube. Results: Three patients with suspected vagal schwannomas were treated surgically using the intracapsular enucleation approach with a combination of intermittent IONM and continuous IONM of the LAR. Conclusion: This combination of continuous and intermittent IONM can be used to preserve vagal laryngeal innervation and function and may represent the future standard of care for vagal schwannoma excision. [ABSTRACT FROM AUTHOR]

Background: Schwannomas, benign tumors arising from neurolemmocytes, are the most common type of peripheral nerve tumors. Extracranial schwannomas are most often found in the parapharyngeal space, commonly involving the vagus nerve to cervical sympathetic trunk. Vagal schwannomas present several unique clinical and therapeutic challenges. Methods: A comprehensive literature review was conducted on 197 articles reporting 235 cases of cervical vagal schwannomas. Presenting symptoms, treatment approach, and postoperative outcomes were recorded and analyzed. Results: Vagal schwannomas commonly present as asymptomatic neck masses. When they become symptomatic, surgical resection is the standard of care. Gross total resection is associated with higher postoperative morbidity compared to subtotal resection. Initial reports using intraoperative nerve monitoring have shown improved nerve preservation. Recurrence rates are low. Conclusion: The combination of intermittent nerve mapping with novel continuous vagal nerve monitoring techniques may reduce postoperative morbidity and could represent the future standard of care for vagal schwannoma treatment. [ABSTRACT FROM AUTHOR]

Cervical vagal schwannoma is an uncommon, benign neoplasm. It is usually asymptomatic and presents as a painless, palpable mass in the neck. However, large schwannomas can cause dysphagia, dysphonia or dyspnea as a result of compression. We report a case of an extremely rare complication of vagal schwannoma in which neck palpation induced the patient to cough. As the patient refused any surgical intervention, conservative management was used. [ABSTRACT FROM AUTHOR]

Horner's syndrome is characterized by triad of blepharoptosis, miosis, and anhydrosis on the lateral part of the face. Incidence of iatrogenic Horner syndrome resulting from neck surgeries has been reported between 10% to 18.5%. Iatrogenic Horner syndrome resulting from excision of cervical vagal nerve schwannoma is uncommon, and has rarely been mentioned in literature. We report a rare case of iatrogenic preganglionic Horner's syndrome resulting from excision of a cervical vagal schwannoma. An 18 years old female presented with the complaints of sudden drooping of right upper lid associated with reduced sweating on right side of face for the past 3 months. There was history of excision of a right cervical vagal schwannoma. Ocular examination revealed mild ptosis, miosis with anisocoria more in scotopic illumination. Photographs of the patient prior to surgery showed no evidence of ptosis. Preoperative Magnetic resonance imaging revealed a mass suggesting a vagal nerve schwanomma. A diagnosis of iatrogenic preganglionic Horner's syndrome was made and the patient was kept under follow up. Horner's syndrome is an uncommon sequelae of cervical vagal schwannoma excision that results from injury of the cervical sympathetic chain intraoperatively and hence should be discussed with the patient during pre-operative counseling. [ABSTRACT FROM AUTHOR]

Schwannoma are relatively rare tumor and even rarer in children. Nerve sheath tumors arising from the cervical nerve are extremely rare. We report a 13-year old boy presented with a history of an asymptomatic right cervical swelling since one year. An ultrasound and FNAC revealed schwannoma. He was meticulously evaluated with MRI. Surgical excision of the lesion was carried out and histopathological examination confirmed the diagnosis. Patient recovered completely without any morbidity. We are presenting this case since it is a rare case and patient recovered without morbidity. It is possible to do the complete surgical excision of schwannoma with complete cure and without complication. [ABSTRACT FROM AUTHOR]

We present a case of a sizeable vagal schwannoma that was resected through a lateral suboccipital approach in semisitting position. An extra-axial lesion, occupying the left cerebellomedullary cistern and extending from the pontomedullary junction to the jugular foramen was incidentally discovered in a 40-year-old woman afflicted with secondary progressive multiple sclerosis during repeated magnetic resonance imaging (Fig. 1). On physical examination, a mild deviation of the uvula to the right and a diminished gag reflex were observed. The patient was referred to our department after considerable growth of the lesion was noted and a broad interdisciplinary consensus was reached to treat the lesion surgically. A gross total resection was achieved, histopathology confirmed a WHO I schwannoma with a low proliferation index. Postoperative dysphonia resolved completely within a few weeks, there was no collateral neurological deficit and especially no functional dysphagia. At 3-year follow-up, there was no indication of residual or recurrence. This 2-dimensional video demonstrates pre- and postoperative imaging, positioning and set-up of operating room, anatomical and surgical nuances of the skull base approach, and the operative technique for microdissection of the schwannoma from the critical neurovascular structures (Fig. 2). In summary, the lateral suboccipital approach in semisitting position is a powerful tool in the armamentarium for the microsurgical management of various pathologies residing in the posterior cranial fossa, especially large and vascularized schwannomas. Provided the necessary anesthesiological precautions and intraoperative procedures the semisitting position is safe and effective. The link to the video can be found at: https://youtu.be/-9o_qJGkQhg. [ABSTRACT FROM AUTHOR]

Abstract: We report a patient with a large, pure intracranial vagal schwannoma, compressing the medulla who presented with essential hypertension. Based on this and on previous cases, we suggest that a differentiation of pure intracranial schwannomas (subtype A1) from intracranial schwannomas with some extension in the jugular foramen (type A) should be used. [Copyright &y& Elsevier]

We present a rare intracranial vagal schwannoma along with its preoperative, intraoperative, and postoperative course., (Copyright © 2019 Elsevier Inc. All rights reserved.)

OBJECTIVE Vagus nerve and sympathetic chain cervical schwannomas (VNCSs and SCCSs) are benign nerve sheath tumors that arise in the head and neck. Despite similar presentations that make accurate preoperative diagnosis more difficult, the potential for morbidity following resection is significantly higher for patients with VNCS. Therefore, the authors analyzed a retrospective case series and performed a comparative analysis of the literature to establish diagnostic criteria to facilitate more accurate preoperative diagnoses. METHODS The authors conducted a blinded review of imaging studies from retrospectively collected, operatively confirmed cases of VNCS and SCCS. They also performed a systematic review of published series that reported patient-specific preoperative imaging findings in VNCS or SCCS. RESULTS Nine patients with VNCS and 11 with SCCS were identified. In the study cohort, splaying of the internal carotid artery (ICA) and internal jugular vein (IJV) did not significantly predict the nerve of origin (p = 0.06); however, medial and lateral ICA displacement were significantly associated with VNCS and SCCS, respectively (p = 0.01 and p = 0.003, respectively). Multivariate analysis demonstrated that ICA and IJV splaying with medial ICA displacement carried an 86% probability of VNCS (p = 0.001), while the absence of splaying with lateral ICA displacement carried a 91% probability of SCCS (p = 0.006). The presence of vocal cord symptoms or peripheral enhancement significantly augmented the predictive probability of VNCS, as did Horner's syndrome or homogeneous enhancement for SCCS. A review of the literature produced 25 publications that incorporated a total of 106 patients, including the present series. Splaying of the ICA and IJV was significantly, but not uniquely, associated with VNCS (p < 0.0001); multivariate analysis demonstrated that ICA and IJV splaying with medial ICA displacement carries a 75% probability of VNCS (p < 0.0001), while the absence of such splaying with lateral ICA displacement carries an 87% probability of SCCS (p = 0.0003). CONCLUSIONS ICA and IJV splaying frequently predicts VNCS; however, this finding is also commonly observed in SCCS and, among the 9 cases in the present study, was observed more often than previously reported. When congruent with splaying, medial or lateral ICA displacement significantly enhances the reliability of preoperative predictions, empowering more accurate prognostication.

Schwannomas are benign, rare peripheral nerve sheath tumors that occur in the head and neck region. Some physicians opt to closely observe cases of schwannoma of the neck on an outpatient basis rather than to perform radical surgery. However, there is a possibility, albeit rare, of malignant transformation of a benign schwannoma. Here, we are reporting the first case from the Indian subcontinent which was transformed into the angiosarcoma from benign vagal schwannoma over a long period. A 47-year-old male patient complaining of left sided neck swelling since last 12 years, swelling was insidious in onset, gradually progressive very slowly. In last 2 months, the size of the swelling was suddenly increased. On examination, there was an approximately 6 cm × 6 cm of size, firm, nodular, well-defined, nontender swelling in the left lateral part of the neck. Fine-needle aspiration cytology (FNAC) revealed paraganglioma and magnetic resonance imaging demonstrated very clearly a tumor, its morphology, and its relation to the surrounding structures, the tumor was thought to be a vagal schwannoma. Surgery was done, and the whole of the tumor was removed in toto. On final histopathological diagnosis, the tumor was proved to be angiosarcoma developed from vagal schwannoma. Postoperative chemotherapy was given but due to distant metastasis, the patient died. Long standing neck masses can convert into malignancy as in our case, therefore, work up of the patient should be done properly. Multiple FNAC should be done because single FNAC can give the false negative result as in our case. This was our diagnostic drawback not to do multiple computed tomography guided FNAC.