Diagnostic and Therapeutic Strategy for Vagal Schwannoma: Case Series and Literature Review

Abstract

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.

A Rare Case of Sudden Massive Neck Tumor

“…1 Schwannomas have the potential to develop along any cranial, peripheral, or autonomic nerve within the human body, with the exception of the olfactory and optic nerves due to the absence of Schwann cells. 2 Research indicates that approximately 25% to 45% of schwannomas are located in the extracranial head and neck region, predomi- nantly in the lateral aspect of the neck. 3 The vagal schwannoma is a solitary, asymptomatic, indolent benign tumor located in the neck.…”

“…A schwannoma, which is alternatively referred to as neuroschwannoma, neurilemmoma, or neurinoma of Verocay, is a nonmalignant neoplasm that arises from Schwann cells located in the cranial, peripheral, and autonomic perineural regions . Schwannomas have the potential to develop along any cranial, peripheral, or autonomic nerve within the human body, with the exception of the olfactory and optic nerves due to the absence of Schwann cells . Research indicates that approximately 25% to 45% of schwannomas are located in the extracranial head and neck region, predominantly in the lateral aspect of the neck .…”