Cervical Schwannoma of the Vagus Nerve: Systematic Review and Two Illustrative Cases

Abstract

Background: Cervical schwannoma is a rare and benign tumor exclusively developed from the cell of Schwann that rarely involve the vagus nerve. Methods: We have conducted a retrospective review with strategy of the consulted references and database included articles published in Portuguese, English and French in PUBMED, MEDLINE, EMBASE, LILACS and SciELO, since 1936 until the present day, associated with a description of two illustrative cases. Both patients presented with a history of painless palpable mass in the cervical region. Results: About 160 cases has been described in literature. Most cases of manifest between the third and sixth decades of the patient's life as a slow growing firm, painless mass in the lateral neck. Imaging is essential to management. Histopathological examination can reveals encapsulated, biphasic spindle cell neoplasia. The best choice of treatment for this type of tumor is complete surgical removal with preservation of the vagus nerve by means of intracapsular resection. In both ilustrative cases the lesions were diagnosed by means of imaging studies and were totally ressected. Surgical findings and histopathology confirmed the diagnosis of vagus nerve schwannoma. There was no recurrence at five years of follow-up. In one case there was disphonya that solved within six months after the surgery. Conclusion: Vagus nerve schwannomas are rare benign tumors. The enucleation technique is used to obtain the most functional preservation and complete excision without permanent deficit is possible even with the occurrence of large lesions.