Intrathoracic tumors arising from the vagus nerve:Review of Resected Tumors in Japan

Abstract

Nineteen surgically treated intrathoracic vagus nerve tumors (16 neurilemmomas, 3 neurofibromas), including three treated by the authors, were reviewed. Tumor resection with vagus nerve amputation was performed in 14 and intracapsular excision without nerve amputation in 3 of the 17 adequately recorded cases. The location of vagus nerve tumor was the left upper mediastinum in 11 patients, almost all of whom were hoarse postoperatively due to sacrifice of the recurrent laryngeal nerve.

Thoracoscopic resection of a vagal schwannoma in the superior mediastinum: A case report

“…The tumor may occur at all ages and does not show a gender preference. Schwannoma is asymptomatic in the majority of cases; however, a number of symptoms, including chest pain, dysphagia, coughing and hoarseness, to varying degrees, may occur due to compression of the neighboring organs (7,8). Hoarseness may occur when the tumor is influenced by the recurrent laryngeal nerve, as was shown in the present case.…”

“…Hoarseness may occur when the tumor is influenced by the recurrent laryngeal nerve, as was shown in the present case. Schwannomas of the vagus nerve are almost twice as likely to be located on the left than on the right, as the recurrent laryngeal nerve arises lower in the thoracic cavity on the left side and the left nerve trunk is thicker (1,8–11). …”

Vagus Nerve Schwannoma in the Middle Mediastinum

“…The natural history of schwannomas is benign and slow-growing. The management of these tumors arising from the intrathoracic vagus nerve is primarily surgical excision to prevent a mass effect or loss of the host nerve function [8]. Malignant schwannomas have also been reported, but these are rarer.…”

A Recurrent Vagal Schwannoma in the Middle Mediastinum after Surgical Enucleation

“…1) In the other 6 cases, hoarseness developed after nerve transection. 2,4,7) However, no other neurologic disability (e.g., dysphagia or aspiration) was reported, although the left recurrent nerves were directly sacrificed in 5 patients, and the vagus nerve was transected proximally to the left recurrent nerve in the remaining patient. Hoarseness resolved in 4 of these patients: Spontaneously in 2 and after otholaryngological procedures in 2.…”

“…However, recurrence after surgery has not been reported. [1][2][3][4][6][7][8] How to manage the involved vagus nerve and avoid postoperative nerve dysfunction is a matter of debate. Whether the involved nerve should be sacrificed to ensure complete tumor excision or be preserved by enucleating the tumor and preserving at least part of its sheath to avoid nerve dysfunction remains controversial.…”