A literature review on surgery for cervical vagal schwannomas

Abstract

Cervical vagal schwannoma is a benign, slow-growing mass, often asymptomatic, with a very low lifetime risk of malignant transformation in general population, but diagnosis is still a challenge. Surgical resection is the treatment of choice even if its close relationship with nerve fibres, from which it arises, threats vagal nerve preservation. We present a case report and a systematic review of literature. All studies on surgical resection of cervical vagal schwannoma have been reviewed. Papers matching the inclusion criteria (topic on surgical removal of cervical vagal schwannoma, English language, full text available) were selected. Fifty-three patients with vagal neck schwannoma submitted to surgery were identified among 22 studies selected. Female/male ratio was 1.5 and median age 44 years. Median diameter was 5 cm (range 2 to 10). Most schwannoma were asymptomatic (68.2%) and received an intracapsular excision (64.9%). Postoperative symptoms were reported in 22.6% of patients. Cervical vagal schwannoma is a benign pathology requiring surgical excision, but frequently postoperative complications can affect patients lifelong, so, surgical indications should be based carefully on the balance between risks and benefits.

Clinical diagnosis and treatment outcomes for parapharyngeal space schwannomas: A single‐institution review of 21 cases

“…Diagnostic imaging enabled preoperative diagnosis of schwannoma in all patients; however, accurate preoperative estimation of the nerves of origin was difficult. One reason for this difficulty was the fact that neural paralysis of the involved nerve, which can be a specific subjective symptom, developed in only 1 of the 21 patients (4.8%), whereas nonspecific subjective symptoms, such as cervical mass and pharyngeal discomfort, occurred in nearly all patients, consistent with previous reports of extracranial schwannoma, 15 cervical vagal schwannoma, 3 and PPS schwannoma. 2 Moreover, although sympathetic chain schwannomas are reported to show no tumor-induced internal carotid artery (ICA)-internal jugular vein (IJV) or common carotid artery (CCA)-IJV separation in the neck, 24,25 nearly half of the patients (5 of 12 patients; 41.7%) in the present study showed this separation, making the differential diagnosis difficult and confusing.…”

“…However, we could only perform intracapsular enucleation in 7 patients because of an anatomic restriction; the narrow surgical field compared to that in the neck. Complete functional preservation of the nerve of origin was not possible in the patients who underwent intracapsular enucleation, which was inconsistent with the relatively favorable outcomes observed in patients with cervical schwannoma . The most likely reason for this is that the working space for the extirpation procedures is inevitably much tighter in the PPS than in the neck, resulting in increased damage to normal nerve fibers because of the increased pressure, which could not fully recover within the follow‐up period.…”

“…Schwannomas are among the most common tumors that occur in the PPS . Subjective symptoms other than perception of a mass are uncommon in patients with cervical schwannoma . However, even the symptoms that make patients aware of the mass do not manifest until a schwannoma in the PPS achieves a certain size.…”

“…In recent years, the concept of intracapsular enucleation, which is based on technical ingenuity, has become popular because it can potentially preserve neural function. Application of intracapsular enucleation for cervical schwannomas has been reported to result in a decrease in the incidence of postoperative neurological deficits in the nerve of origin . However, no study performed to date has investigated differences in the efficacy of extirpation methods, including intracapsular enucleation, in terms of the occurrence of postoperative neurological complications exclusively in PPS schwannomas.…”

“…2 Subjective symptoms other than perception of a mass are uncommon in patients with cervical schwannoma. 3 However, even the symptoms that make patients aware of the mass do not manifest until a schwannoma in the PPS achieves a certain size. Therefore, like other PPS tumors, PPS schwannoma is sometimes diagnosed incidentally during diagnostic imaging performed for other purposes.…”