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.
Highlights
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
Cervical schwannoma typically presents as a slowgrowing asymptomatic mass, well circumscribed and encapsulated [3], having an enlargement of 2.5 to 3 mm per year [6], always intimately adherent to its nerve of origin [7] and displacing the internal jugular vein laterally and the carotid artery medially
Most schwannomas were asymptomatic (68.2%); hoarseness was present in four patients (18,2%)
Summary
Nerve schwannomas, English language and full text available; papers on nonsurgical treatment of cervical vagus nerve schwannomas, with a language different from English, or with nonavailable full text were excluded. Demographic and clinical characteristics of patients, schwannomas and related symptoms description, surgical procedures and postoperative outcomes were evaluated when reported and compared. The onset was estimated on the third and fourth decade in 50% with a median age at diagnosis of 44 years (range 10 to 80). Maximum diameter ranged between 2 and 10 cm with a median value of 5 cm. Most schwannomas were asymptomatic (68.2%); hoarseness was present in four patients (18,2%). Syncope was described just in one patient (4.6%). All patients included in these studies were surgically treated. Intracapsular enucleation was the technique of choice by the majority of surgeons (64.9%); about one third were extracapsular resections (32.4%) whereas debulking of tumour was described in just one patient (2.7%). Six studies (with a total of 24 patients) did not specify the site of incision
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